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Reconciliation Bill Passes, But Health Reform Battle Not Over for GOP

Janice Simmons, for HealthLeaders Media, March 26, 2010

After more than a year of healthcare reform proposals, debates, and deliberations, the House brought the process to a close shortly after 9 p.m. Thursday with a 220-207 vote approving the healthcare reconciliation package that had been sent over from the Senate six hours earlier. The bill (HR 4872) now proceeds to President Obama for his signature.

Just hours before, the President spoke in Iowa City, IA, where he first announced his plan for healthcare reform in May 2007. "This is the reform that some folks in Washington are still hollering about, still shouting about," he said. "Now that they passed it, they’re already promising to repeal it. They’re actually going to run on a platform of repeal in November. You've been hearing that. And my attitude is: 'Go for it.'"

In both chambers, the atmosphere was calmer and quieter on Thursday compared to Sunday night when the House passed the initial healthcare reform bill from the Senate (that was signed by the President on Tuesday). In the early afternoon in the Senate, a moment of silence was observed for Sen. Edward Kennedy (D-MA), an advocate of healthcare reform, who died from a brain tumor exactly 200 days earlier. The senators, observing the historical nature of the bill, voted from their desks.

In a 56-43 vote—with a simple majority needed—the Senate approved the reconciliation measure. Over the past two-and-a-half days, Republican members had proposed dozens of amendments. None passed though some received a few Democrat votes. One of the reasons for the amendments was to make sure the bill—if it changed—would be sent back to the House.

The bill did have to return to the House for a final vote Thursday because of a minor provision related to the Pell education grants that were attached to the reconciliation measure. Republicans had objected to the provision because it did not reduce the deficit as required under the budget rules—and the Senate parliamentarian agreed.

The reconciliation bill approved by both chambers contains provisions making changes to the initial Senate healthcare reform bill signed by the President this week. The House asked for the ability to incorporate changes in exchange for supporting the Senate bill.

The bill contains new provisions on:

  • Specifying premium tax credits.
  • Eliminating the gap or "doughnut hole” in Medicare prescription drug coverage (with a $250 rebate this year).
  • Freezing and reducing Medicare Advantage payments.
  • Permitting dependent children through age 26 to be included on parents' plans.
  • Providing a Medicare bonus to primary care physicians and general surgeons working in underserved areas.

"In passing this bill, we have truly completed what the late Sen. Edward Kennedy called 'the great unfinished business of our society,'" House Speaker Nancy Pelosi (D-CA) said after the House vote.

Although both bills passed this week, Republicans have been promoting a new slogan: "Repeal and replace." House Minority Leader John Boehner (R-OH) said in a statement Thursday evening: "The mistakes Democrats have made will require correcting sooner rather than later—with new legislation, new regulations, and new spending. But there’s only one way to truly undo the damage this law will do to our economy and our freedoms: repeal and replace."

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