House Steams Toward Health Reform Vote

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The House is steaming toward a historic vote on President Obama's remake of the U.S. health care system, with Democratic leaders increasingly confident and the powerful seniors' lobby AARP about to get on board.

A debate and vote are expected Saturday on the 10-year, $1.2 trillion bill that would extend coverage to 96 percent of Americans, require employers to insure their employees and bar such insurance company practices as dropping coverage for sick people.

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Democratic leaders shrugged off Tuesday's election losses in governor's races in Virginia and New Jersey, focusing instead on their wins in two House races, a Democratic seat in northern California and one in New York that had long been held by the GOP. Both winners will be sworn in ahead of Saturday's vote.

Leaders stopped short Wednesday of declaring they had the 218 votes needed to pass the bill, and they were still negotiating language on abortion and immigration. But scheduling the vote meant those issues would have to be resolved and undecided lawmakers would have to declare themselves.

"It is human nature to sort of keep discussing until decision time is at hand," Majority Leader Steny Hoyer, D-Md., said after meeting with second-year lawmakers Wednesday evening. "Decision time is upon us."

Said House Speaker Nancy Pelosi, D-Calif.: "We are on our path. We're very excited."

Action is slower on the other side of the Capitol, where senators are awaiting an analysis from the Congressional Budget Office on legislation written by Senate Majority Leader Harry Reid and others. The timeline there appears likely to spill into next year.

The House effort is getting a big boost from the AARP, which was set to endorse the bill, something that proved a crucial stamp of approval when then-President George W. Bush pushed the Medicare prescription drug benefit through a closely divided Congress in 2003.

Officials with knowledge of the group's decision disclosed it ahead of Thursday's scheduled announcement, speaking on condition of anonymity because it was not yet official.

If the AARP's clout doesn't close the deal for House Democrats, Obama is expected to try to do it himself with a visit to Capitol Hill on Friday.

With no Republican backing for the measure, Democrats will need overwhelming support from their own. A festering intraparty disagreement over how to prevent federal funds from being used to pay for abortion has not yet been entirely resolved, though language being circulated by one anti-abortion Democrat, Rep. Brad Ellsworth of Indiana, was getting interest from House leaders Wednesday.

Ellsworth's language would strengthen stipulations already in the bill against federal money being used to pay for abortions but still would allow people to pay for abortion coverage with their own money. That distinction doesn't satisfy the most ardent anti-abortion groups, which dismiss it as an accounting gimmick since the same insurance companies paying for abortions might also be getting federal money for other coverage plans.

The National Right to Life Committee issued a blistering press release Wednesday night calling Ellsworth's proposal "a political fig leaf made out of cellophane."

Ellsworth said that didn't bother him.

"I know what's in my heart, I know what's in my head and I think the big guy upstairs knows," Ellsworth said. He said that if his language is adopted he could "rest assured that no public dollars are going to fund abortions."

House leaders are also still grappling with illegal immigration, specifically whether illegal immigrants - who would be barred from getting federal subsidies - should be able to purchase insurance coverage within new government "exchanges" using their own money.

The White House does not want this allowed, but some members of the Congressional Hispanic Caucus and other Democrats view that position as too extreme. Caucus officials were scheduled to meet with Obama at the White House on Thursday.

The House bill would provide government subsidies beginning in 2013 to extend coverage to millions who now lack it. Self-employed people and small businesses could buy coverage through the new exchanges, either from a private insurer or a new government plan that would compete. All the plans sold through the exchange would have to follow basic consumer protection rules.

Seniors in traditional Medicare would get improved preventive benefits. Also, the prescription coverage gap known as the "doughnut hole" would be gradually closed. However, seniors signed up for private insurance plans through Medicare could lose some benefits, as the bill scales back extra payments that the plans have been getting.

In addition to raising money by cutting payments to hospitals and other medical providers, the House bill boosts taxes on upper-income earners.

Meanwhile, the CBO released an analysis of the House GOP bill that found it would reduce the number of uninsured by just 3 million in 2019. By comparison, the more expansive Democratic bill would gain coverage for 36 million.

While the Democrats' bill would cover 96 percent of eligible Americans, the Republican alternative would cover 83 percent - roughly comparable to current levels. The budget office said the Republican plan would reduce federal deficits by $68 billion over the 10-year period and push down premiums for privately insured people.
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