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President Obama Signs Landmark Health Care Bill

Senate now goes to work on changes to the law

In a historic climax to a bitter year-long political battle, President Obama signed into law today landmark legislation to overhaul the nation’s health care system.

During a ceremony in the East Room of the White House, the president told a crowded audience, “We have now just enshrined … the core principle that everybody should have some basic security when it comes to their health care.”

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He called the measure “an extraordinary achievement that has happened because of all of you and because of all the advocates all across the country.”

The signing came just two days after the House passed the legislation by a vote of 219 to 212. All House Republicans voted against the bill, as did 34 Democrats.

The House first passed the bill already approved by the Senate.

In the turbulent days leading up to passage, Obama and Democratic leaders contended not only with fierce opposition from Republicans but also with the reluctance of some liberal and conservative House Democrats, who objected to certain provisions in the Senate bill. In the end, those members agreed to approve both the Senate bill and a package of changes.

Changes sought by House Democrats were incorporated into a second measure called a reconciliation bill, which went to the Senate today. Senate Majority Leader Harry Reid assured House Democrats last weekend that he has the votes to pass it.

The sweeping legislation represents an achievement for Obama that previous presidents—Theodore Roosevelt, Franklin D. Roosevelt, Harry Truman, Richard Nixon, Jimmy Carter and Bill Clinton—have sought for nearly a century.

What’s in the measure

Ultimately, starting in 2014, the measure will extend affordable health insurance to some 32 million currently uninsured Americans; penalize employers who do not offer coverage and individuals who do not purchase it; provide subsidies for people with limited income and moderate income; and prohibit insurers from denying coverage to people with preexisting medical conditions.

“We applaud the House for passing this critical legislation to make our health care system work for more Americans,” A. Barry Rand, CEO of AARP, said in a statement.

Provisions that take effect within a year include: banning insurers from arbitrarily canceling or limiting coverage; providing tax credits to small businesses that offer coverage; providing temporary insurance (until 2014) for people who have been denied it because of their health; allowing young people to stay on their parents’ insurance until age 26; requiring insurers to use a high percentage of premiums for benefits instead of profits or overhead; and making preventive measures, such as cancer screening, free.

Basic Medicare benefits guaranteed

The legislation guarantees basic Medicare benefits and gradually closes the “doughnut hole” in drug coverage, starting with a $250 rebate this year, and a 50 percent discount for brand-name drugs in the gap next year. It adds free annual exams and other free preventive care. It also phases in cuts in government subsidies to private Medicare Advantage plans, which, with other savings, extends Medicare’s solvency by nearly a decade.

The cost of the reforms—$940 billion over the next 10 years—is fully paid for by reining in fraud, abuse and waste in Medicare, and levying a new tax on high-end “Cadillac” health plans and higher taxes on the wealthy. According to the independent Congressional Budget Office, reform savings will also trim the federal deficit by $143 billion through 2019.

Democrats described the legislation as the capstone of a 100-year effort. Rep. Steny Hoyer, D-Md., said, “Illness and infirmity are universal,” but the country is stronger when it fights them together instead of alone. “That shared sense is our nation’s strength,” Hoyer said. “In this bill is a more prosperous and just future.”

Critics speak out

Republicans derided the bill, contending it raises taxes, penalizes small businesses that can’t afford to offer health coverage to employees, and gives the government too big a role in health care. They called the bill unconstitutional and predicted it will spark a wave of lawsuits.

“Older Americans will see their benefits evaporate,” said Rep. Fred Upton, R-Mich.

Raucous crowds

The measure sparked a polarized debate outside the marble walls of the Capitol. Protesters gathered all weekend, many of them angry about tax increases and what they see as a big-government plan. Some Democratic lawmakers reportedly faced ugly name-calling—including racial slurs—from protesters.

Rep. Louise Slaughter, D-N.Y., said a brick had been hurled through a window in her New York district office.

Inside the fractious House chamber, the parties skirmished over parliamentary matters, and sometimes members shouted and booed.Rep. Connie Mack, R-Fla., said Democrats have won a temporary victory through back-room dealing. “Let’s see who’s still here after the American people speak loud and clear in November,” he said.

Polls show public wariness over the legislation, especially among seniors, because Medicare would be trimmed more than $500 billion, including slowing down the growth in payments to doctors and reducing the subsidies to the Medicare Advantage program.

But Judy Feder, a professor of public policy at Georgetown University, said some of the Medicare changes, like a new focus on managing chronic illness, should make the program more effective, and that will have a huge impact. “When Medicare leads, the private sector follows. It’s about changing the health care system,” she said.

But former top GOP Senate aide Dean Rosen, a partner with Mehlman Vogel and Castagnetti, a political consulting firm, said Republicans likely will gain more politically from the debate than Democrats because tax increases will go into effect before many of the benefits are available.

Democrats “are going to have their work cut out for them after it passes to sell it to the American people.”

Tamara Lytle was Washington bureau chief and a correspondent for the Orlando Sentinel from 1997 to 2008.

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