The Health Care Debate Opens On The House Floor

The U.S. House of Representatives this morning finally opens debate on its health care overhaul bill, the centerpiece of President Obama's domestic agenda. Host Scott Simon talks to NPR's Julie Rovner about the debate and where the legislation stands.

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SCOTT SIMON, host:

This is WEEKEND EDITION from NPR News. I'm Scott Simon.

The U.S. House of Representatives finally opens debate today on its health care overhaul bill. President Obama is making the trip up to Pennsylvania Avenue to lobby lawmakers in person and advance the vote, which could be close. NPR's Julie Rovner joins us. She's been covering the health care debate all year. Julie, thanks very much for being with us.

JULIE ROVNER: My pleasure.

SIMON: Remind us. This version that may draw a vote, what's in it?

ROVNER: Well, there are three main goals to the bill. It is to help provide coverage to people who don't have it, to shore up coverage for people who do, all the while slowing the rise of health costs. The bill would require everyone to have insurance, most employers to help pay for it, and the government to provide subsidies to poor and middle-class people.

Now, the Congressional Budget Office says the bill would cover about 36 million more people. That's about 96 percent of the population that's here legally, since illegal immigrants won't be eligible for benefits. For people who have insurance, it would end the practice of denials based on preexisting conditions, things like charging women more because they tend to use more health care, and imposing annual and lifetime benefits limits. Those are things that today often lead people to be what we call underinsured.

On the cost side, the bill would pay for itself, says the CBO, largely through reductions in Medicare spending and a new tax on high-income earners - people generally earning over about a half a million dollars. But it wouldn't do as much as many health economists had hoped to really change health care instead of do what they call bend the health care cost curve.

SIMON: And we keep hearing that the Democrats need to drum up votes from within their own caucus. Does this mean a hope of bipartisan support for this or any bill is gone?

ROVNER: Well, certainly this bill - there's not much hope of bipartisan support. It went through three different committees on its way to the floor -not a single Republican vote. That means that the 258 Democrats in the House right now, including the two new members elected this week, the leaders have to find 218 to get the bill through. It is proving surprisingly difficult.

SIMON: Why?

ROVNER: Well, they've got pretty much two issues that have been dogging them for months now - abortion and immigration. On abortion, the goal was to write a bill that was policy neutral, that basically didn't change the status quo, which is that federal funds shouldn't be used to pay for abortion but that most private plans do offer abortion as a benefit.

The problem is that with these subsidies that are going to be going to private plans, you have now the specter of offering federal funds to pay for private plans, so there's still this fight about how to craft that language.

On immigration, there's widespread agreement that no benefits should go to people who are here illegally. But in the House bill, there is a provision that says people here illegally could use their own money to buy coverage in these new marketplaces called exchanges. That's not in the Senate bill. President Obama has expressed a preference for the Senate bill. That has angered about 20 members of the House Hispanic Caucus, who are threatening not to vote for the bill if that language is taken out.

SIMON: This bill in the House of Representatives got a couple of high-profile endorsements late in the week, right?

ROVNER: Yes, indeed it did. The AARP and the American Medical Association endorsed the Democrats' bill. Here's AARP executive vice president Nancy Leamond.

Ms. NANCY LEAMOND (AARP): We've read the House of Representatives' Affordable Health Care for America Act, and we can say with confidence that it meets our priorities for protecting Medicare, providing more affordable insurance for 50-to-64-year-olds, and reforming our health care system.

ROVNER: Here's the American Medical Association president, James Rohack.

Mr. JAMES ROHACK (American Medical Association): Now, HR-3962 is not a perfect representation of the AMA's view, but it's consistent with enough of our goals to warrant support to keep the process moving.

SIMON: This day and age, there are a lot of political analysts that question the value and utility of endorsements.

ROVNER: Yeah, there are. And you know, both of these endorsements were expected - the AMA in particular, because doctors are looking at a 20 percent cut in pay under Medicare unless Congress does something to fix it by January. So they are pretty much over a barrel. They pretty much had to endorse this bill.

But you know, it's certainly better to have groups backing your bill than not. And certainly the public is very confused about this issue and they tend to look to groups that they trust. And these are, for better or worse, groups that much of the public trust. So indeed, these were considered big endorsements in terms of this bill and certainly groups that the Democrats courted very strongly.

SIMON: What's the status of this or any legislation in the Senate?

ROVNER: Well, the Senate's in a bit of a holding pattern. They are waiting for the Congressional Budget Office, who's been working on the House bill, to give them estimates of the bill that Senate Majority Leader Harry Reid's trying to put together. They're hoping to perhaps start a debate by the end of the month. That could be on the Senate floor probably until Christmas.

SIMON: And happy holidays, Julie.

ROVNER: Thanks, Scott.

SIMON: NPR's Julie Rovner, thanks for being with us.

ROVNER: You're welcome.

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