Pelosi unveils healthcare bill; House moves toward floor vote

Speaker Nancy Pelosi (D-Calif.) rolled out her long-awaited healthcare reform bill Thursday, but she may have some problems getting it to the House floor.

Several factions of House Democrats are threatening to block consideration of the bill using procedural moves unless their demands are met.

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Liberals, who lost their leading priority of a “robust” public health insurance option, said they want an up-or-down vote on that alternative. If not, they may vote against the “rule” that is needed to bring up any major bill on the floor.

“We don’t want to challenge the rule, but the need for an up- or-down vote … is something members want,’ said Rep. Raúl Grijalva (D-Ariz.), co-chairman of the Congressional Progressive Caucus.

It’s not clear how many liberals might join Grijalva in trying to block the bill, but Rep. Bart Stupak (D-Mich.) said he already has enough anti-abortion Democrats to, in the parlance of the House, “take down the rule.” Stupak wants a more complete ban on taxpayer money funding abortions, which House leaders appear unwilling to grant.

And members of the Congressional Hispanic and Asian-Pacific caucuses may also demand their own up-or-down votes on an amendment to repeal the constraints placed on legal, documented immigrants wanting to sign up for government-subsidized health insurance.

Asked how leaders know they can pass the new bill, a senior House aide said, “Because we have to.”

Though the threats show that House Democrats remain divided on key issues, both liberal and centrist Democrats emerged from a morning caucus meeting ebullient that a healthcare bill finally seems within reach.

“This is the best, most historic healthcare bill we’re going to get,” said Rep. James McGovern (D-Mass.), one of 60 liberals who’d signed a bill pledging to vote against a letter without a “robust,” Medicare-based public option. “At the end of the day, we have to pass something.”

Centrist lawmakers, including Blue Dog Democrats, were celebrating Pelosi’s decision to go with a public option in which the government will negotiate rates individually with providers.


It won over Rep. Earl Pomeroy (D-N.D.), who’d steadfastly withheld his support because he says Medicare shortchanges providers in his state. He announced his support for the new bill to a loud cheer in the closed-door caucus.

“That’s a big win,” said Rep. Baron Hill (D-Ind.), a Blue Dog leader who helped broker the “negotiated rates” compromise in July in the House Energy and Commerce Committee.

The $894 billion bill would extend coverage to 36 million people, ensuring coverage for 96 percent of the country, excluding illegal immigrants.

The full cost of the bill is $1.055 trillion, but $167 billion in revenue from penalties to be paid by those without insurance make the “net coverage” costs $894 billion, according to the Congressional Budget Office.

Pelosi and House leaders say President Barack Obama’s $900 billion figure was for net coverage. But the Senate has used total cost, rather than net coverage.

“The president left ambiguity there,” said Pomeroy, a member of the fiscally conservative Blue Dog Coalition. “Further discussions will need to be held on that.”

The CBO also said the House plan would reduce the federal deficit by $104 billion over the next 10 years. In the 10 years after that, the plan would “probably” create “slight reductions” in the deficit, though that estimate is “subject to substantial uncertainty.”

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The second 10-year period appears to be causing heartburn for the fiscally conservative Blue Dog Democrats. The group's leadership wrote a letter to the CBO asking for clarification about whether it would cut the deficit or add to it over 20 years. The four leaders said the answer could determine how they and other Blue Dogs vote.

“In order to make an informed decision about the legislation, we believe it is necessary to have as full and clear a description of its long-term budgetary effects as CBO can provide,” the letter said.

Republicans decried the bill as a complex takeover of the health system by the federal bureaucracy.

They marched an entire hardcopy of the Democrats’ nearly 2,000-page healthcare bill before TV cameras to denounce the measure for raising taxes, creating mandates and cutting Medicare.

“Nineteen hundred and ninety pages; that’s about four reams of paper. I can say that the people who are getting reamed are the American people,” Rep. Joe Barton (R-Texas) said at a press conference surrounded by fellow top-ranking House Republicans.

But Pelosi has labored for weeks to bring enough Democrats on board so she doesn’t need GOP votes. Extensive whip counting showed the Medicare-based option couldn’t get the necessary 218 votes. Less counting, if any, has been done on the negotiated-rates compromise.

Pelosi celebrated the announcement with a ceremony on the west steps of the Capitol that included speeches by lawmakers, horror stories from citizens mistreated by health insurance companies and a small contingent of protesters off to the side.

“We have listened to the American people,” she said. “We are putting forth a bill that reflects our best values and addresses our greatest challenges.”

Later in the day, members of the Progressive Caucus went to the White House, where Obama was likely to try to assuage their disappointment on losing their version of the public option and try to keep them on board for the healthcare vote.

Democrats indicated that debate on the bill will start late next week. They need to wait at least six days to live up to their promises to give lawmakers and the public time to read the bill. The bill rolled out Thursday will be up for three days, after which leaders will introduce a tweaked final version, called the “managers amendment.”

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House Majority Leader Steny Hoyer (D-Md.) said the earliest a House vote could occur would be next Thursday.

“We’re going to have 72 hours to not read the bill,” quipped Rep. Anthony Weiner (D-N.Y.), mocking critics of the measure.

The House is supposed to be out the following week for Veterans Day, but leaders said the debate could go through the weekend and into the days before the holiday.

“We would go through the weekend, through Monday or Tuesday, and get home for Veterans Day,” said House Rules Committee Chairwoman Louise Slaughter (D-N.Y.). “If we need to, we will.”

In addition to the public option the bill includes provisions to,

• End the anti-trust exemption for the health insurance industry and cap industry profits at 15 percent. The healthcare industry has irritated Democratic leaders in recent weeks by releasing a study saying the bill would raise premiums. Democrats were angry that the study ignored a provision that would reduce premiums.

• Allow Medicare to negotiate drug prices with drug makers, making the pharmaceutical industry another loser in the bill. The industry has fought such a provision for years, managing to keep it out of the Medicare prescription drug benefit when Congress was run by Republicans. The provision flies in the face of a deal the Obama administration and Senate leaders have made with the industry not to allow such negotiations in exchange for giving up $80 billion in profits.

• Expand eligibility for Medicare, the government health plan for the poor, to those making one and a half times the federal poverty income level. That was added because the “negotiated rates” option costs $85 billion more than the “robust” plan. Medicaid pays less than Medicare, so the Medicaid provision expands coverage at a lower cost.

The bill also includes an income surtax on the wealthy to pay much of the cost of the bill. But Pelosi raised the income thresholds to $500,000 for individuals and $1 million for families. The original bill had lower income thresholds, sparking protests from members, especially freshman Democrats.

Raising the income thresholds on the tax appears to have appeased some of the freshmen, who objected to the tax soon after Democratic leaders introduced it last summer.

“I’m very pleased with the direction things are going. I’m thrilled they’re moving in the right direction,” said Rep. Jared Polis (D-Colo.), who drafted a letter to leadership from 20 freshmen opposing the tax.

Polis said he could not commit to voting for the bill until he reads it. But he occupied a prominent spot at Pelosi’s roll-out ceremony. So did fellow freshman Rep. Gerry Connolly (D-Va.), who’d also signed the letter.

None of the leaders of the Blue Dog Coalition or the Progressive Caucus attended the event, though their rank and file members did. The only caucus chairmen who attended were Rep. Joe Crowley (D-N.Y.) of the New Democrats and Rep. Mike Honda (D-Calif.) of the Asian-American Pacific Islander Caucus.

Only two lawmakers listed as “no” votes on a leaked whip count for the robust public option were on stage — Rep. Kathy Dahlkemper (D-Pa.) and Rep. Steve Kagen (D-Wis.).

Leadership aides said “no decisions” have been made about what amendments would be allowed on the floor, although Grijalva said he’d heard reports from lawmakers that the bill would have a “closed rule,” meaning no amendments.

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And Slaughter, the Rules chairwoman, indicated that she didn’t expect Stupak’s anti-abortion amendment to be allowed. Stupak believes that government subsides for people purchasing private insurance could direct tax dollars to abortions, and wants insurance participating in the bill’s “exchanges” banned from covering abortion.

“I don’t see that as open at this point,” Slaughter said. “Bart Stupak is one of my best friends, but he’s wrong about this. There’s no money for abortion in this bill.”

Weiner, who had been promised a floor vote on a “single-payer” amendment, said he’d been “told all systems are go.”

But Pelosi signaled a reluctance to allow amendments, though she added she is open to the idea and has not yet made up her mind.

“I’d have to be talked into it, I think, but — let’s put it this way — I’m open to it,” Pelosi said during a conference call Thursday afternoon with liberal bloggers.

She said that she considered the variety of meetings in recent weeks with her caucus members as tantamount to having allowed amendments.

“We’ve probably had 78 caucuses on this subject, where we’ve listened to members — they’ve had I think 2,000 town meetings on the subject,” she said, adding: “I’ve considered all of that input as our amendment process.”

Molly K. Hooper and Michael O’Brien contributed to this article.