Health care reform legislation, declared dead so many times by its enemies and sometimes its friends, became an accomplished fact last night via House enactment of the Senate-passed bill. The House also passed the closely associated reconciliation bill “fixing” the Senate bill, and final action on that measure in the Senate will take a while. But no matter: the most important health care legislation since the enactment of Medicare in 1965 is on its way to the president’s desk. It will ultimately provide coverage for 32 million people lacking health insurance; will finally outlaw the denial of insurance (or outrageous premiums for) those with pre-existing conditions, beginning with children; will undertake the most serious effort yet to move the health care system from payment for procedures to payment for good health results; and is estimated to reduce federal budget deficits by $120 billion in its first decade. For dessert, the bill closes the arbitrary “donut hole” for the Medicare prescription drug benefit.
The winding road leading to this accomplishment almost defies description, particularly after Republicans gained a 41st seat in the Senate in January and with it the ability to veto any legislation that didn’t proceed under budget reconciliation rules. After endless mockery for their handling of the issue last year, the administration and the Democratic congressional leadership all earn a great deal of credit for the ultimate victory: Harry Reid for getting all 60 Senate Democrats on board for a bill in December; Nancy Pelosi for the deft negotiations that produced 219 votes in the House; and the White House and the president for refusing to heed a thousand calls to totally revamp or abandon the legislation.
And despite the many conflicts among Democrats over the composition of the ultimate bill, it’s significant that joy over the vote last night extends all across the party, from single-payer fans to managed competition advocates to all sorts of people focused on narrow issues. It appears we owe a special thanks to the Catholic nuns whose strong support for the legislation seems to have shamed Rep. Bart Stupak and several other House colleagues into a face-saving deal on abortion language, mainly a symbolic gesture offered to secure real live votes.
Now Republicans, of course, are predicting a huge public backlash and then a quick repeal of the legislation if and when they retake control of Congress. There will be a lot of noise made in the days just ahead by Tea Party activists who have become invested in apocalyptic rhetoric about the dangers of health reform, and perhaps others who have bought some of the lies and distortions conservatives deployed to fight this legislation, from wild claims about “death panels” to pervasive predictions that premiums will skyrocket and Medicare benefits will be cut. When these disasters don’t occur, much of the negative excitement will die down, even as the merits of health reform become more apparent.
As for threats that the bill will soon be repealed: the very tools of obstruction that Republicans so eagerly utilized to try to thwart health reform will be available to those trying to stop its repeal. Will 60 senators vote to withdraw health coverage from tens of millions of Americans any time soon? Will 60 senators go to the mats to re-establish the “right” of insurance companies to deny coverage to children with pre-existing health conditions? Will Republicans vote to re-open the Medicare prescription drug “donut hole”? Where will they find the funds to offset elimination of health reform’s deficit savings? Maybe they ignored the president’s recent arguments about how the most popular reform measures won’t work without a comprehensive approach. But if Republicans try to repeal reforms piece-meal, they’ll finally figure out what he was talking about.
All in all, it’s clear that President Obama and most congressional Democrats did one thing that cynical voters don’t much expect of politicians these days: they kept a promise to meet one of America’s most urgent national challenges, and they kept it despite a collective Republican decision against any cooperation, despite vast institutional barriers in the Senate, and despite predictable public nervousness about — and, for many, hostility towards — comprehensive action on such a complex issue.
That’s an accomplishment worth celebrating, extending and, if necessary, defending. Let’s prove America’s not ungovernable after all.