After the House and Senate both passed their respective health care reform bills, the two chambers had intended to reconcile those two bills into a final package. After the House and Senate passed that final package, it would have been sent to President Obama, who would have signed it into law. Sen. Scott Brown (R-MA), however, won a special election to replace the late Sen. Ted Kennedy (D-MA) before the final health care bill could be brought up for a vote. Brown's victory gave Republicans 41 votes in the Senate, thus depriving Democrats of the 60-vote majority they needed to defeat a Republican filibuster against the final health care bill.
In order to pass comprehensive health care legislation without a 60-vote majority in the Senate, Democratic leaders devised a plan in which the House would pass the Senate health care bill (H.R. 3590), thereby enabling the president to sign it into law. The House would then pass a separate companion bill (H.R. 4872) to make changes to the Senate health measure. Assuming the Senate passed the companion bill, that measure would then go to the president for signature as well. This process allowed the House to make changes to Senate-passed health
care legislation without sending the entire health bill back to the Senate, where it could be filibustered indefinitely.
The House had already passed the companion bill on March 21, 2010. The Senate then made a number technical changes to the measure, and sent it back to the House. Senate Republicans succeeded in striking a number of sections of the bill that did not conform to budget reconciliation rules. These modifications did not change the substance or cost of the bill, but merely forced the House to vote on it a second time.
This was the vote on the resolution setting a time limit for debate and prohibiting amendments to the companion bill making changes to the Senate health care legislation. Those changes included delaying the implementation of the tax on high-cost insurance plans until 2018. Democratic leaders brought up H.R. 4872 under a process known as budget reconciliation. This process shielded the bill from a filibuster in the Senate. If a bill is filibustered, it must have the support of 60 senators in order to end debate and vote on the legislation. Under budget reconciliation, bills can pass the Senate with a simple 51-vote majority.
H.R. 4872 would increase the number of uninsured Americans that would be covered under the health care bill by 1 million -- resulting in an expansion of coverage to 32 million individuals, as opposed to 31 million. An estimated 95% of Americans would have access to health insurance under the legislation.
H.R. 3590 placed 40% tax on high-cost insurance plans -- or those plans that are worth more than $27,500 for families, and $10,200 for individuals. Under the reconciliation bill (H.R. 4872), the tax would not take effect until 2018.
H. R. 4782 also contained a major provision -- unrelated to health care -- that would phase out a program in which the federal government guaranteed loans made to students by private lenders. Under the bill, students would instead receive loans directly from the federal government.
Rep. Louise Slaughter (D-NY) called for swift passage of the legislation: "I won't even bother reciting all of the ways in which ordinary Americans will gain as we shift the balance of power away from insurance companies and back to patients, because they will know very shortly. I have already spoken at length about how under our bill families will no longer feel trapped by their coverage or fearful about children with preexisting conditions. Health care reform, I am happy to say, is now the law of the land. I encourage my colleagues to join me today in quickly adopting these small technical fixes to the legislation so we may move on to more pressing challenges."
Rep. Jim McGovern praised Democratic efforts to pass health care reform legislation: "We voted to end the most abusive practices of the insurance companies, to provide coverage to millions of hardworking families, to bring down the costs of health care for families and small businesses, and to pass the biggest deficit reduction package in 25 years. That reform is now the law of the land. Already, we hear from our friends on the other side of the aisle saying that they want to repeal that law. They want to allow insurance companies to once again discriminate against people because of preexisting conditions….They want to continue to let families go bankrupt because of their medical bills."
Rep. David Dreier (R-CA) criticized Democrats for failing to craft a bi-partisan health bill, and vowed that Republicans would work to pass legislation more to their liking: " We will work to ensure that government bureaucrats never come between patients and doctors. We will make sure that no one will be forced to give up their current coverage if they do not so choose, and that those who have diligently saved in their health savings accounts are not in any way punished. If we can abandon the failed tactics that the Democrats in charge have put forward and work in an bipartisan and open fashion, these are the kind of real reforms that can be enacted so all Americans will have access to quality, affordable health insurance."
Rep. Paul Broun (R-GA) warned that the legislation would have dire consequences: " The first thing that it will do is it's going to drive millions of people out of work. Also, besides that, it's going to drive many doctors out of business…When people have that free health care insurance card issued by the federal government in their pocket, it's going to be about as worthless as the Confederate dollar was after the Civil War because you are not going to find any doctors who are going to be willing to take the government insurance card."
The House agreed to the resolution setting a time limit for debate and prohibiting amendments to the companion reconciliation bill by a vote of 225-199. 225 Democrats -- including all of the most progressive members -- voted "yea." All 174 Republicans present and 25 Democrats voted "nay." As a result, the House proceeded to formal floor debate on legislation giving 32 million uninsured Americans access to heath insurance, delaying a tax on high-cost health insurance plans until 2018, and phasing out a program in which the federal government guaranteed loans made to students by private lenders (Under the bill, students would instead receive loans directly from the federal government.).