Democratic Congressman Bart Stupak of Michigan tells The Associated Press he'll retire from Congress rather than seek a 10th term this year.
Stupak has drawn stinging criticism from opponents of the recently enacted health care overhaul after leading a bloc of anti-abortion Democrats whose last-minute support was crucial to its approval by the House.
The Tea Party Express is calling for his defeat at rallies in his sprawling northern Michigan district this week.
But Stupak tells the AP the attacks didn't influence his decision and he could win re-election if he tried.
He plans to announce his decision at a 12:30 p.m. news conference at Northern Michigan University in Marquette.
He says he wants to spend more time with his family and start a new career after 18 years in Congress.
It sounds like Vice President Joe Biden dropped the "f-bomb" at the health care reform signing ceremony Tuesday.
On video captured by network cameras and reviewed by POLITICO, Biden can be heard whispering to the president: "This is a big f---ing deal."
The audio isn't flawless. But a canvass of reporters from several news organizations who also reviewed the tape produced a consensus that Biden did, indeed, go there.
And in a Twitter message just before 1 p.m., White House press secretary Robert Gibbs appeared to acknowledge the hot-mic moment, writing: " And yes Mr. Vice President, you're right..."
The crack puts Biden in rarified company: On "60 Minutes" last Sunday, profanity-prone White House chief of staff Rahm Emanuel said that he's only cussed in the Oval Office around Obama once, and that he tries to keep his verbiage clean in the presence of the president whenever possible.
A call to Biden's spokesman wasn't immediately returned.
Sources: Whitehouse.gov, TMZ, Fox News, Politico, NY Post, Youtube
Rep. Paul Ryan (R-Wis.), one of his party’s top voices on fiscal matters, calls the newly passed health reform plan a “fiscal Frankenstein” that will “make insurance more expensive,” providing an opening for the GOP to push for a partial repeal.
Ryan, the top Republican on the House budget committee, said the plan will help “a very small segment of the population,” such as people with pre-existing conditions, but make life more expensive for “the vast majority of the population.”
“What matters to people is: Are their premiums going up or are their premiums going down?” Ryan said in an interview as his Capitol Hill office for the POLITICO video series, “Health Care Diagnosis.”
Ryan, who calls himself “a numbers guy” and resists talking about political strategy, said he’ll be pushing for what he calls a “repeal and replace” approach to rolling back the law Obama signed on Tuesday.
“You’re going to see sticker shock,” Ryan said. “You’re going to see lots of premium increases. You’re going to see people in the individual market losing their premiums, losing their insurance. … All brokers of insurance are gone in a year, in my personal opinion.”
“Obviously we’re not for keeping this law,” he continued. “We should repeal it and replace it with reform … but not just to go back to the status quo that we knew yesterday. That wasn’t sustainable, either. We’ve been saying all along we want to fix what’s broken in healthcare without breaking what’s working in healthcare. So repeal and replace it with something better.”
Asked if Republicans had overplayed their hands with dire claims about the plan, Ryan replied: “The problem I see with this bill is: Is this bill socialized medicine today? No, but it think it clearly puts us on the trajectory for that. ... So what I’m worried about is in our nation, we’re reaching a tipping point in this country where more Americans are more worried about their government benefits and dependencies than they are about their own securities. … They’re more relying on the government for their livelihoods than they do on themselves.”
Ryan said he’s begun laying the groundwork for his role as one of his party’s appointees to President Barak Obama’s newly formed deficit-reduction panel, the National Commission on Fiscal Responsibility and Reform.
“I’m mailing them my entitlements plan,” he said. “We’re sending them some things that we’ve already written, … just so you know who I am and what I’ve been saying, to be very candid. Anybody who knows anything about me knows I’m not a tax increaser . . . . spending, in my opinion, is the problem.”
Ryan acknowledged speculation that the commission was designed to provide cover for recommendations for tax increases, but he said he’s willing to wait until the group gets going because deciding what he thinks of it.
“I want to get something done, I want to be constructive, I want to approach it with a good attitude,” he said. “If this thing, this commission can help us get spending under control, I want to help, and that’s what I’m going to be offering.”
Last month, Ryan introduced a “2.0” version of his “Roadmap for America’s Future,” which includes proposals for health care, retirement savings, job training, and tax and budget reform. The plan made Ryan a convenient target for Democrats, who claim it’s a sugarcoated attempt to partially privatize Social Security and Medicare.
“President Obama kind of elevated it and then [Budget Director Peter] Orszag came after it and the DCCC and the DNC , so now I’m sort of the punching bag,” he said. “I’m OK with that. I’m actually very, very much at peace with it because what the Democrats … are trying to do is win this next election by tearing down Republicans and making us seem worse than they are.
“They don’t want an election as a referendum on their performance; they want an election based on fear and if they can disperse fear into the mind of a voter about Republicans, they can stay in power. So what’s comforting to me: In order for them to attack my plan, they have to completely demagogue it -- meaning mischaracterize it -- and that’s good, in my mind. … [I]t tells me that I put up a viable alternative to the social welfare state they want to create for America.”
Ryan said the “new media economy” makes it easier for a minority party to promote its alternative ideas. “You have a [presidential] bully pulpit that heretofore could kind of concentrate and control the media,” he explained. “This bully pulpit it not as singularly effective, because of all the new media that’s out there.
“So when I get demagogued by the president and the Democrats, … I have avenues where I can get the truth out about this plan. The point I’m trying to make is when people find the facts, they know there’s something wrong, they know debt’s getting out of control and they know we’ve got to do something to fix it.”
“I don’t care if I lose this job for trying to do what I think is right,” he added. “The way I look at this is: Every term you should act like it’s your last term. And what matters to me is that you sleep well at night.”
The congressman paused and grimaced. “OK,” he said. “Last night I didn’t sleep very well because of this health-care bill.”
1.)Pelosi Called Opponents Of Government-Run Health Care Experiment "Un-American." (Speaker Nancy Pelosi & Rep. Steny Hoyer, "'Un-American' Attacks Can't Derail Health Care Debate," USA Today, 8/10/09)
2.) Last Night, Pelosi Once Again Ignored The Will Of The American People And Voted Again To Pass Their Government-Run Health Care Experiment. (H.R. 3590, Roll Call Vote #165, Approved 219-212; D 219-34; R 0-178, 3/21/10)
3.) Yesterday's Vote Came Just Four Months After Pelosi Rammed Through $1.2 Trillion Health Care Bill On A Saturday Night. (H.R. 3962, Roll Call Vote #887; Approved 220-215; D 219-39; R 1-176, 11/7/09)
4.) Leading Up To The Vote, Pelosi Made Clear Once Dems "Kick Open That Door ... There Will Be Other Legislation To Follow ... We'll Take The Country In A New Direction." (Greg Sargent, "Pelosi: Passing Health Reform Will Set Stage For Great Debate With GOP," The Plum Line, 3/15/10)
5.) Pelosi Claims To Be Unaware Of The Behavior Of Disgraced Former Rep. Eric Massa, And Continued To Defend Rep. Charlie Rangel Despite Ethics Committee Admonishment. (James Hohmann, "Nancy Pelosi Defends Charlie Rangel, Again," Politico, 2/26/10; MSNBC's "The Rachel Maddow Show," 3/11/10)
6.) In June, Pelosi "Laid Down The Gauntlet" To Rush Through Cap And Trade National Energy Tax. (Steven T. Dennis and Tory Newmyer, "Pelosi Flexes Muscle," Roll Call, 6/24/09; H.R. 2454, Roll Call Vote #477; Approved 219-212; D 211-44; R 8-168, 6/26/09)
7.) In February Of Last Year, Pelosi Passed President Obama's $862 Billion Stimulus, Promising To Create Jobs; Yet Since Then, America Has Lost 3.3 Million Jobs. (H.R. 1, Roll Call Vote #70: Passed 246-183; R 0-176; D 246-7, 2/13/09; U.S. Bureau Of Labor Statistics, www.bls.gov, Accessed 3/5/10)
8.) Pelosi Has Failed To Run House In Spirit Of Bi-Partisanship, With Democratic Members Being "Explicitly Told Not To Work With Republicans." (Rep. Jim Cooper, "Reconciliation Rules - Not Bipartisanship - Will Kill Health Care Reform," The Huffington Post, 6/18/09)
9.) Despite Pelosi Promising "The Most Open And Honest Government In History," Even Dem Member Admits "Caucus Is A Real Disappointment" Because They "Aren't Transparent." (Rep. Nancy Pelosi, "Pelosi: 'We Will Create the Most Open and Honest Government in History'" Press Re lease, 1/18/06; Glenn Thrush, "Sestak Blasts Pelosi, Obama On Transparency," Politico, 1/7/10)
10.) Pelosi Accused The CIA Of Lying To Her And To Congress On Use Of Interrogation Techniques. (David Espo, "Pelosi on CIA: 'They Mislead Us All the Time,'" The Associated Press, 5/14/09)
This weekend, House Speaker Nancy Pelosi ensured that the 111th Congress will live in infamy. Instead of listening to the people she used every procedural trick at her disposal to pass her health care legislation. She must be stopped.
Over the last year, the American people have witnessed a Speaker who will stop at nothing to achieve her vision of a Leftist government. She believes that she is no longer accountable to congressional rules, and national laws. Those are just guidelines that can be tossed away on a whim if determined they will prevent her from accomplishing her goals.
On Sunday, she cast them aside with reckless abandon and forced through her government takeover of health care.
Nancy Pelosi has no regard for public opinion. Even in a hostile electoral environment, she asked members of her caucus to fall on their swords so that she might add another achievement to her increasingly shameful legacy. Her actions are deceptive, dishonest, and simply unconstitutional, but she shows no remorse. To her, the ends justify the means.
Let there be no doubt: Nancy Pelosi’s sole priority in this entire health care drama has been authorizing a government seizure of the American health care industry and nationalizing a full one-sixth of our economy. She ignored the cold hard facts of the federal budget. Plainly put, you cannot add $1 trillion dollars to the budget and then claim that it’s revenue neutral, cut $500 billion from Medicare, and won’t affect recipients.
The math simply doesn’t work. But Nancy Pelosi doesn’t seem to have any problem with fudging the numbers when it’s to her advantage.
Worse yet, Speaker Pelosi has claimed that she would preside over the most ethical and transparent Congress in history. She has repeatedly denied Americans their Constitutional right to know what Washington is doing in their name, because she knows that if they find out, they will hold her caucus accountable.
For the sweetheart deals and arm-twisting tactics; for this unconscionable dereliction of her duty; for this gleeful defiance of the Constitution; and for the utter contempt with which she has repeatedly treated the American people, Speaker Pelosi MUST be fired.
The time has come for Americans to speak out. If you believe that American government should be open, honest, and transparent; if you believe that individual Americans, not the federal government, are best equipped to make their own medical decisions; if you believe that the Constitution of the United States – not this radical leftist agenda – is still the ultimate authority in our land, I am asking for your help to fire Nancy Pelosi.
I am asking you to pledge your support to punish her and every Democrat who joined her in this abomination and help Republicans regain the majority in the House.
The voice of the people was ignored on health care, but with your help we will make sure they hear it loud and clear when we remove Speaker Pelosi from her throne this November.
President Barack Obama capped a yearlong political drama Tuesday, signing into law a landmark health care reform bill that had been seen as impossible just two months ago.
The president said the law "will set into motion what a generation of Americans have fought for."
He said he was confident the Senate would make fixes to the legislation "swiftly."
The president praised those House members who had "taken their lumps" during the overhaul debate. Shouted one lawmaker in the audience to laughter, "Yes we did!"
He also hailed the new law, saying it helps lift a "decades-long drag" on the economy.
With Victoria Kennedy, widow of the late Sen. Edward Kennedy in the audience, Obama took note of the long battle to bring the health overhaul measure to his desk. "He was confident we would do the right thing," the president said of the longtime lawmaker.
"We are not a nation that does what's easy ... we are a nation that faces its challeges and faces its responsibilities."
Now, Obama must sell the law's merits to a wary American public.
House and Senate Democrats who backed the bill, as well as ordinary Americans whose health care struggles have touched Obama , oined him for the ceremony at the White House. Afterward, they headed to the Interior Department for an even larger celebration.
The White House did everything possible to make sure Obama's health care victory lap carried the day with no competition. A planned announcement of the administration's new drug control policy by Vice President Joe Biden was called off, White House press secretary Robert Gibbs declined to hold his regular daily briefing for reporters and all Obama's meetings were closed to coverage, including one with Israeli Prime Minister Benjamin Netanyahu.
The next act begins Thursday, when Obama visits Iowa City, Iowa, where he announced his health care plan as a presidential candidate in May 2007. There Obama plans to talk about how the new law will help lower health care costs for small businesses and families, selling the overhaul to Americans who are deeply divided over the plan.
Republicans united in opposition pledged to repeal Obama's redesign of the health care system, which they criticized as a costly government takeover affecting one-sixth of the U.S. economy. The Republicans lack the votes needed to repeal the measure, but the minority party plans to use the issue to try to regain control of Congress in the November elections.
Democrats argue that they have delivered on Obama's campaign pledge for change, revamping a system in which the spiraling costs have put health care and insurance out of the reach of many Americans.
After a rancorous debate, the House voted 219-212 late Sunday to send the 10-year, $938 billion bill to Obama. Not one Republican voted for the bill. Some Democrats also voted against it.
The measure, which the Senate passed in December, eventually will extend coverage to 32 million uninsured Americans, reduce federal budget deficits and ban such insurance company practices as denying coverage to people with existing medical problems.
The bill will bring near-universal coverage to a wealthy country in which tens of millions of people are uninsured. The plan's various provisions will be phased in through 2014, and it is expected to expand coverage to about 95 percent of eligible Americans, compared with 83 percent today.
The measure represents the biggest expansion of the U.S. federal government's social safety net since the 1960s, when President Lyndon B. Johnson enacted the Medicare and Medicaid government-funded health care coverage programs for the elderly and poor.
A companion measure sought by House Democrats to make a series of changes to the main bill was approved 220-211. It goes to the Senate, where debate could begin as early as Tuesday. Majority Leader Harry Reid says he has the votes to pass it — though only under special budget rules requiring just 50 votes rather than the 60 usually needed to bypass the opposition's delaying tactics.
Republicans plan to offer scores of amendments to slow or change the companion measure, which Democrats hope to approve as written and send directly to Obama for his signature.
Even so, the health care debate will likely continue for months as both parties try to use it to motivate their backers to turn out in huge numbers in the November congressional elections.
Republican-leaning states are already lining up to sue the federal government over the constitutionality of the health care overhaul legislation. Officials in at least 10 of the 50 states have agreed to file a lawsuit challenging it on grounds it violates state sovereignty by mandating that all Americans have some form of health insurance. Experts say the effort will likely fail because the U.S. Constitution states that federal law supersedes state laws, but it will keep the issue alive until the November elections.
Obama's yearlong campaign to overhaul health care seemed at a dead end in January, when a Republican won a special election to fill the late Edward Kennedy's Massachusetts Senate seat, and with it, enough votes to prevent the bill from coming to a final vote in the Senate.
But the Democrats regrouped and soon came up with a rescue plan that required the House to approve the Senate-passed measure despite opposition to many of its provisions, then have both chambers pass a measure incorporating numerous changes.
Obama has pushed health care as his top priority since taking office in January 2009. Failure would have weakened him and endangered other issues on the president's ambitious domestic agenda, including immigration reform and climate change legislation.
So-called tea party activists, who believe that government spending and influence should be limited, are vowing to exact political revenge on those who passed it.
The government "has declared war on our way of life," activist Eric Odom from Nevada said Monday.
In Florida, about 85 tea party groups have about 100,000 members, according to Everett Wilkinson, a leader in the state's movement. A rally was planned in Boca Raton later Tuesday.
The movement's name is taken from the Boston Tea Party, a 1773 protest in which activists in the then-British colonies in America boarded ships and threw their cargo of English tea into Boston Harbor in a symbolic act of protest against taxes.
President Obama will sign landmark health-care legislation into law Tuesday without waiting for the Senate to deal with a package of revisions that was also approved by the House late Sunday, administration officials said.
Officials unveiled the plan to use a signing ceremony to showcase the benefits of the health-care overhaul after a divided House passed the Senate-approved bill and the separate revisions, known as a reconciliation bill, in a marathon Sunday session that culminated more than a year of political discord over Obama's signature domestic initiative. By a 219-212 vote, the House approved the Senate bill, handing Democrats a historic victory in a long-running battle to reform the nation's $2.5 trillion health-care system. The vote for the reconciliation bill was 220-211. No Republican voted for either measure.
Amid continuing recriminations over the bill and Republican protests against it, Rep. Randy Neugebauer (R-Tex.) publicly acknowledged Monday that he was the lawmaker who yelled "baby killer" at Rep. Bart Stupak (D-Mich.) as the leader of antiabortion Democrats was speaking on the House floor in opposition to a GOP motion Sunday night. But Neugebauer said in a statement that his remark was misinterpreted and that, in any case, he has apologized to Stupak.
"In the heat and emotion of the debate, I exclaimed the phrase 'it's a baby killer' in reference to the agreement reached by the Democratic leadership," said Neugebauer, 60, who has represented a swath of North Texas in the House since 2003. "While I remain heartbroken over the passage of this bill and the tragic consequences it will have for the unborn, I deeply regret that my actions were mistakenly interpreted as a direct reference to Congressman Stupak himself."
The Senate will begin work on the House-passed revisions as soon as Obama signs the broader legislation, said Jim Manley, spokesman for Senate Majority Leader Harry M. Reid (D-Nev.). The debate will be limited to 20 hours and likely will end early Thursday, Manley said. Then begins a series of votes on amendments, a process with no time limit but that allows for just one minute between votes.
At the moment, Democratic Senate leaders are uncertain how long the voting process will last, although most senators still expect to leave more or less on schedule for a two-week recess scheduled to begin Saturday. Still unclear is whether the GOP will succeed with any of the numerous procedural challenges it is expected to mount against the bill.
Bipartisan discussions with the Senate parliamentarian began late Monday morning, but Manley said Democratic leaders have already vetted the fixes bill for potential hitches and identified no provisions that could be jettisoned and result in derailing the $940 billion package.
White House officials said Obama intends to sign the main bill during an event that will include a diverse group of guests, some of whom the president has used before to promote his health-care plans. He was hoping to do so on the South Lawn of the White House, but a rainy forecast made it more likely that the ceremony would be held indoors at the Interior Department, press secretary Robert Gibbs said.
Invitees will include doctors and nurses, citizens who will benefit from some of the bill's provisions, and members of Congress instrumental in passing it. Aides said many details are still in the works, including how big the guest list will be.
That Obama will hold a high-profile event, even though the Senate has yet to approve revisions to the final legislation, indicates a White House desire to capitalize on the historic nature of the bill rather than allow to frame it as an expensive government intrusion into a sector that accounts for one-sixth of the national economy.
The legislation is certain to be a major element of the midterm election campaign season. Obama plans to travel Thursday to Iowa City, Iowa, to underscore the bill's immediate effects.
Gibbs told reporters Monday afternoon that the administration does not expect legal challenges to the health-care legislation from Republican-governed states to be successful. Among others, Virginia's Republican attorney general, Ken Cuccinelli II, has vowed to file suit on grounds that a federal requirement for individuals to buy health insurance is "unconstitutional."
"My advice from counsel is that we'll win these lawsuits," Gibbs said. "We're confident that this process is coming to an end."
Gibbs said former president Bill Clinton played a key last-minute role Sunday in helping to persuade some reluctant House Democrats to vote for the Senate-passed health-care bill. After the vote, Secretary of State Hillary Rodham Clinton, who had unsuccessfully championed a health-care overhaul during her husband's presidency, was "very happy" that Obama had succeeded, Gibbs said.
"She walked over and gave him a big hug for what had been accomplished," the spokesman said.
In remarks Sunday night, Obama said that the vote "proved that we are still capable of doing big things. We proved that this government -- a government of the people and by the people -- still works for the people."
House Speaker Nancy Pelosi (D-Calif.) and her colleagues erupted in cheers and hugs as the votes were counted, while Republicans who had fought the Democratic efforts on health-care reform for more than a year appeared despondent.
"Today we have the opportunity to complete the great unfinished business of our society and pass health-insurance reform for all Americans as a right, not a privilege," Pelosi said before the House approved the bill, which first passed the Senate on Christmas Eve.
The debate has consumed Obama's first year in office, with his focus on the issue amid a deep recession and crippling job losses potentially endangering his reelection prospects and Democratic majorities in the House and the Senate. It has inflamed the partisanship that Obama pledged to tame when he campaigned for the White House and has limited Congress's ability to pass any other major legislation, at least until after the midterm elections in November.
And it has sparked a citizens' revolt that reached the doors of the Capitol this weekend.
"If we pass this bill, there will be no turning back," House Minority Leader John A. Boehner (R-Ohio) warned on the floor. "In a democracy, you can only ignore the will of the people for so long and get away with it."
The bill will affect virtually every man, woman and child in the United States in some way, from the 20-somethings who constitute one of the largest uninsured groups to poor, childless adults who don't qualify for Medicaid in most states to well-paid professionals who could see their benefits shrink. The health-care debate touched on many highly charged moral issues in American life, and a handful of antiabortion Democrats held up a final deal until late Sunday afternoon, before reaching a breakthrough with the White House.
Along with the Senate's blueprint for reform, the House late Sunday approved a package of fixes to the legislation that will face a potentially rocky journey through the Senate this week. Over the next 10 years, the measure will set in motion a complex series of changes to the health insurance market that will translate into the biggest expansion of coverage since Medicare and Medicaid were created in 1965, and the most ambitious effort ever to restrain health-care costs.
Presidents as far back as Theodore Roosevelt have rued the nation's approach to health coverage, a system that serves relatively well the 150 million Americans who receive health insurance through their jobs but provides few affordable options for people who work part time, are self employed or work for companies that don't offer health benefits.
Obama conveyed to the wavering House Democrats who visited the White House in recent days that he had put his presidency at risk by pushing the House to act on the Senate bill. Although many House Democrats found the Senate legislation lacking, passing it was the only option after Republican Scott Brown won a Massachusetts special Senate election in January and cost Democrats their filibuster-proof majority in that chamber.
The 34 Democratic defectors were fewer than the 39 who voted against the House version approved in November, but the number was substantial enough to underscore the political uncertainty for many Democrats, especially those who represent moderate to conservative districts.
While the vote delivers on a major Obama campaign promise, it also solidifies Pelosi as a political risk taker with a deep understanding of how far every member of her Democratic caucus is willing to bend. Along with Obama, Pelosi was one of the few prominent Democrats who didn't flinch when Brown won his Senate seat. Instead, she sold her caucus on the Senate legislation, orchestrating the fixes bill to address major concerns and secure enough votes for passage.
The last issue resolved before the vote was the long-standing question of whether federal subsidies in the bill could be used to pay for insurance policies that provide abortion services. A handful of Anti-Abortion Democrats feared that the Senate language didn't provide adequate restrictions, and they refused to vote for the legislation unless the firewall was made more secure.
Democrats who support abortion rights refused to accept any legislative changes. But on Tuesday, Rep. Bart Stupak (D-Mich.), the leader of the antiabortion faction, ran into White House Chief of Staff Rahm Emanuel at the House gym, and Emanuel offered a compromise: Obama could issue an executive order clarifying the ban on federal funding of abortion. Stupak and six colleagues eventually agreed to the executive order, which was announced by the White House on Sunday afternoon and is scheduled to be issued after the bill is signed.
"I've always supported health-care reform," Stupak told reporters, after concluding marathon talks with party leaders. But he added, "There was a principle that meant more to us than anything, and that was the sanctity of life."
On Sunday night, the House acted first on the legislation that cleared the Senate on Christmas Eve. That measure devotes $875 billion over the next decade to expanding insurance coverage, with the major changes coming in 2014. An estimated 24 million people who lack access to affordable coverage through the workplace will be eligible for tax credits to buy insurance on new state-based exchanges, while nearly everyone who earns less than 133 percent of the federal poverty level -- an estimated 16 million people -- will become eligible for Medicaid.
For the first time, individuals will pay a price for refusing to buy insurance, facing fines of at least $750 a year starting in 2014. And employers with more than 50 workers that do not provide coverage may also face significant fines.
Medicare, the federal health program for people over 65, will undergo significant changes intended to deliver care more efficiently and at a lower price, with the aim of using the nation's largest insurance plan to force doctors, hospitals and other private-sector players to follow suit.
Medicare Advantage, a form of Medicare provided by private insurance companies to about 11 million seniors, will lose nearly $120 billion over the next decade, probably forcing providers to drop popular add-on benefits such as gym memberships.
The legislation also includes smaller changes that will take effect this year. In six months, new insurance policies will have to permit adult children to stay on their parents' policies until they turn 26. And small businesses with fewer than 25 employees and average annual wages of up to $50,000 will receive tax credits to offset the cost of buying insurance for their workers.
Meanwhile, insurance companies will be subject to new rules: In six months, all new plans will have to cover the full cost of preventive care, including annual physicals and children's immunizations. Insurers won't be able to require prior approval for patients who need to see gynecologists or go to the emergency room.
Children with medical conditions will no longer be denied coverage, and states will receive $5 billion to create high-risk insurance pools to provide affordable coverage to adults with preexisting conditions. Insurers will also be barred from imposing lifetime limits on benefits and from dropping people when they file a claim.
For seniors, the bill will immediately expand the Medicare drug benefit and, effective July 1, provide a 50 percent discount on brand-name drugs for the low-income elderly.
Many provisions of the Senate bill would be altered by a separate package of amendments that the House also approved Sunday, by a vote of 220 to 211. That package now goes across the Capitol to the Senate under special rules, known as reconciliation, that protect it from a Republican filibuster.
Compared with the Senate bill, that measure would offer more generous subsidies to people eligible for federal help buying insurance. Tax credits would be available to families earning as much as 400 percent of the federal poverty level -- or about $88,000 a year for a family of four -- who would be assured of spending no more than 9.5 percent of their income on insurance premiums in 2014.
The reconciliation package would also gradually close the gap known as the "doughnut hole" in Medicare prescription drug coverage, which leaves many seniors to pay the full cost of expansive medications.
House Democrats also insisted on changing major sources of funding for the legislation, particularly the Senate's proposal to impose a 40 percent excise tax on the most generous employer-provided policies, starting in 2013. That tax would hit many middle-class families, including many union members, so the House reconciliation package proposes to delay its implementation until 2018.
The additional cost of the reconciliation package would be covered instead by increasing Medicare taxes for high earners and by imposing a new 3.8 percent Medicare tax on investment income for those families.
The package would also change the penalty on people who fail to purchase insurance, requiring them to pay at least $695 a year or as much as 2.5 percent of their income. And it would increase the fines for large employers that fail to offer affordable coverage to $2,000 per worker.
Combined with the Senate bill, the package would increase the overall cost of expanding insurance coverage to $940 billion over the next decade. But the two measures combined would also lower budget deficits by $143 billion by 2019.
Democrats have spent weeks scouring the package to make sure it can clear the complicated procedural hurdles that face any reconciliation bill in the Senate, but Republicans are just starting their review of the final package. Sen. Judd Gregg (N.H.), the senior Republican on the Senate Budget Committee, has already identified at least one provision that he believes could bring the entire bill down, arguing that a new tax on high-cost insurance policies would have an impact on the Social Security trust fund -- a violation of reconciliation rules.
Senate Democrats believe they can overcome that challenge, and Senate Majority Leader Reid on Saturday publicly assured House Democrats that he has the votes to pass the bill.
U.S. Rep. Randy Neugebauer of Lubbock is a banker, a quiet, polite guy who has made few waves in Congress and was little known beyond West Texas until he shouted out "baby killer" during the tense final hours of the health care debate.
"I'm just trying to represent the people of the 19th Congressional District," Neugebauer told Lubbock TV station KCBD on Monday. "The intensity of the American people was represented in my intensity last night. ... I still believe that that Senate bill is a baby-killing bill."
Neugebauer, a Republican, also denied that he was calling Democratic colleague Bart Stupak a name; he said that his full comment referred to the health care legislation itself.
But the fallout was immediate, as Neugebauer was the subject of daylong media reports and White House condemnation. His Democratic opponent called the outburst "embarrassing" both for Neugebauer and the people of West Texas. Allies called it an uncharacteristic flash of intensity from a four-term, 60-year-old Republican whose anti-abortion views run deep.
Both Wilson and his Democratic opponent quickly raised copious sums of campaign cash after the incident. Neugebauer seemed more sheepish than defiant Monday as he confessed to being the heckler Sunday night.
He issued a written apology to the U.S. House, and he called the apparent target, Stupak, to explain himself.
Democrats viewed it as a damaging pattern of self-inflicted GOP behavior as health care came to a head, in step with racial epithets hurled at black lawmakers and anti-gay slurs aimed at Rep. Barney Frank, D-Mass. These comments, strategists said, kept the focus away from GOP complaints about the cost of the bill and how it was "crammed" down Americans' throats.
At the White House, press secretary Robert Gibbs chastised the heckler, even as he acknowledged that passions ran high.
"We ought to be able to have that debate without the type of language and actions that we've seen in some places over the weekend," he said.
Neugebauer cruised to re-election by a ratio of 3-1 in 2008 and ran unopposed in the GOP primary this month. This year's Democratic opponent, engineer and first-time candidate Andy Wilson, has raised less than $7,000, about 1 percent of the incumbent's war chest.
Wilson said he would have voted for the bill, adding that he finds it "ironic" that Neugebauer would shout at Stupak, who led a group of anti-abortion Democrats demanding guarantees against taxpayer support for abortion.
Lubbock County GOP chairman Chris Winn said Neugebauer has zero to fear in terms of voter backlash. Quite the contrary, he said, because the comments reflect the passions of his constituents.
"Congressman Neugebauer represents his district as a Christian conservative and has done so with a great deal of respect," Winn said. "He's a gentleman, and his words should not be taken as hateful or cruel."
Abortion foes say Neugebauer was right in saying the legislation expands the federal role in paying for and promoting abortion. At the Texas Alliance for Life, executive director Joe Pojman noted that his district is safely Republican.
"He's always been solid on life issues. ... We've always been supportive. This won't change that, obviously," Pojman said.
Neugebauer's other spotlight moment came last summer, when he backed the "birther bill" requiring presidential candidates to show proof they were born on American soil. The liberal MSNBC host Keith Olbermann called him the "Worst Person in the World" for saying he wasn't sure if Obama would qualify.
As for Stupak, he accepted the personal apology but said the breach called for a more explicit apology to the House.
"I also let him know that, while we all have had a very long week and tensions were high leading up to the vote Sunday night, I feel it is important for members to maintain decorum of the House," the Democrat said.
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