The House took a historic vote late Sunday night to approve an overhaul of the nation's healthcare system after more than a year of debate, a few near-deaths for the measure and an intense final week marked by loud and angry protests outside the Capitol.
The House voted 219-212 to send an overhaul measure the Senate passed in December to the president's desk. It also voted 220-211 to approve a package of fixes to the Senate bill. The Senate bill passed amid opposition from every Republican and 34 Democrats. The corrections bill passed with opposition from every Republican and 33 Democrats.
For many House Democrats, the passage represented an historic landmark legislative achievement for President Obama and themselves -- alongside Franklin Roosevelt's signing the Social Security Act and Lyndon Johnson's enactment of Medicare and Medicaid.
"We'll be joining those who established Social Security, Medicare and now tonight health care for all," Speaker Nancy Pelosi, D-Calif., told members just before the vote.
Minority Leader John Boehner, R-Ohio, begged to differ: "This institution is broken and, as a result, this bill is not what the American people need or what our constituents want."
Speaking late Sunday night from the White House, Obama praised the passage of his signature domestic priority, saying, it was "a victory for the American people" that, while it might not "solve every problem" in the healthcare system, "moves us in the right direction."
The Senate will take up the corrections bill that reflects changes to the Senate measure as early as Tuesday. Senate Democrats have 52 votes to pass the fixes, a Democratic aide said. Vice President Joe Biden would break a tie, but with 52 votes it does not appear his vote will be needed. Senate Majority Leader Harry Reid, D-Nev., sent Pelosi a letter promising he has the votes to pass the fixes, but did not publicly release how many votes exactly.
Boehner attempted to cast doubt on the assurance, calling up the one provision in the fixes the GOP feels strongly it can trip up Senate Democrats on. The provision is one that pushes back a tax on high-cost health plans until 2018 under a deal with unions at the White House's request. Republicans argue reconciliation cannot alter Social Security law, which they say the tax would do.
"The bill does not increase Social Security taxes or make any changes in the Social Security Act," the office of House Majority Leader Steny Hoyer, D-Md., argued in a statement. "In fact, the increased Social Security revenues are an indirect result of the health insurance reforms in the legislation."
If the Senate parliamentarian rules the provision is challengeable, the point of order would require 60 votes to overcome -- votes the Democrats do not likely have.
House Democratic leaders worked throughout the week to bring on fence-sitting members, altering language to provide for more equity in Medicare reimbursements in rural areas and, lastly, reaching an agreement with anti-abortion Democrats on Sunday afternoon. Rep. Bart Stupak, D-Mich., and a handful of other anti-abortion Democrats negotiated an executive order that would clarify a ban on federal funding of abortion.
The agreement on the executive order put Democrats over the 216 votes they needed to pass the bill. "I do believe they had the votes even before," Stupak said when he announced the deal around 4 p.m. on Sunday.
"What do you have -- nothing or the executive order, which has the force of law?" he asked. "I'll take the executive order."
Boehner argued any president can change an executive order at any time. "Make no mistake, a 'yes' vote on the Democrats' health care bill is a vote for taxpayer-funded abortions," he said.
Stupak disagreed. "All due respect to Leader Boehner, it's not true," he said.
In a bit of high drama on the House floor, Stupak took to the microphone to challenge a Republican motion to recommit, saying the motion was not an anti-abortion measure as depicted by its sponsors. The GOP brought up a motion to recommit in between the vote on the Senate bill and one on the corrections bill that they argued reflected the abortion language Stupak included in the House bill in November no longer under consideration.
Rather, Stupak told his House colleagues the Republican motion was "an opportunity to continue to deny to 32 million Americans an opportunity for health care."
As Stupak was speaking, someone from the Republican side of the chamber yelled out "baby killer."
Republican at first denied it came from their ranks, suggesting it came from the visitor's gallery above.
But Rep. John Campbell, R-Calif., told reporters asking him about the shout that he heard it, and it came from someone sitting behind him and to his left, and sounded like "a Southern accent."
Campbell went back into the chamber, then returned back outside to a group of reporters to add that he was told a group of Texans were sitting in that area, and that "people who know won't give it up."
The $940 billion overhaul will extend insurance coverage to 32 million people, in part by requiring people to have insurance, offering tax credits to help them buy coverage and extending Medicaid to those earning up to 133 percent of the federal poverty level. The legislation will create a new marketplace, or exchanges, where people can shop for insurance and will prohibit insurance companies from denying coverage based on preexisting conditions. CBO estimates the bill will reduce the deficit $138 billion over 10 years.
The bill is offset in part by a Medicare payroll tax on unearned income and a tax on high-cost plans. Pharmaceutical companies, medical devicemakers and insurance companies also are taxed to help fund the overhaul. The bill making the fixes fully closes the Medicare Part D coverage gap known as the doughnut hole by the end of the decade.
The Rev. Jesse Jackson, proudly holding court outside of the House chamber as his son, Rep. Jesse Jackson Jr., D-Ill., presided inside over a portion of the day's debate, described the healthcare vote as the latest push-and-pull of what has been an historic "tug of war between hope and fear" in America. Pointing to such historic legislation as the Voting Rights Act, Jackson said, "All of these significant changes come with resistance and great fear."
He also indicated this is only the beginning, saying it changes the "frame" of the healthcare system. Comparing it to the Voting Rights Act, he said, "Once the frame changed, other battles were relatively small."
Some Democrats who voted against the overhaul are already feeling the heat from unions. AFL-CIO President Richard Trumka was on Capitol Hill throughout Sunday. AFL-CIO and the Service Employees International Union let Rep. Jason Altmire, D-Pa., know they were unhappy with him in a joint letter Sunday morning informing him they intend to hold him accountable.
"We find it pretty outrageous that he's talking about not supporting healthcare reform," SEIU Secretary-Treasurer Anna Burger said before the vote.
Altmire, who did vote "no," ran on healthcare reform, Burger said, and unions rallied behind him with support and resources. Burger said they will begin searching for a Democrat to challenge him.
As the lawmakers debated on the floor, and eventually voted, thousands of demonstrators surrounded the Capitol. They hoisted banners, and chanted, "Kill the bill! Kill the bill!" and "no, no, no," or "Freedom! Freedom!"
More than once, House Republicans walked out onto a balcony adjoining the speaker's lobby outside the chamber, waving and joining -- or inciting -- them in their chants.
To underscore a bit of solidarity, Pelosi in the early afternoon joined arm-and-arm with other House Democrats, including Rep. John Lewis, D-Ga., in a walk across the street from the Cannon House Office Building to the Capitol.
The walk was a symbolic ode to Lewis' having led voting-rights marchers onto the Edmund Pettus Bridge outside Selma, Ala., where they were tear-gassed by state troopers on what became known as Bloody Sunday. It came on the heels of some lawmakers on Saturday having become targets of anti-gay and racist language by demonstrators outside the Capitol. This time, as the demonstrators shouted and jeered, Pelosi and her entourage were tightly guarded by Capitol Police.