The House on Thursday moved toward a Sunday vote on a historic remaking of the U.S. health care system, buoyed by an independent analysis that said the $940 billion, 10-year measure will cut the federal deficit.
While increasing federal spending to provide health subsidies for many of the 32 million uninsured Americans who would get coverage under the plan, the package lowers the deficit by imposing a new Medicare tax on unearned income such as dividends for high-income earners and by controlling increases in health care costs.
The legislation will cut the deficit by $138 billion over its first 10 years and lead to continued savings beyond that, the nonpartisan Congressional Budget Office said.
"This is but one virtue of a reform that would bring accountability to the insurance industry and bring greater economic security to all Americans," said President Obama, who postponed a trip to Asia to continue pushing for the
passage of the health plan.
The new budget projections highlighted a flurry of activity on health care Thursday, as the House rejected a GOP attempt to derail the "Slaughter Solution" method of passing the bill and as House staffers released details of the legislation.
While it was still unclear whether Democrats had lined up enough votes to pass the bill, Republicans will "do everything that we can do to make sure this bill never, ever, ever passes," said House Minority Leader John Boehner, R-Ohio.
That task appeared to get more difficult, however, as the budget numbers offered cover to cost-conscious Democrats.
"A lot of members will be much more comfortable with this bill based on that savings," House Majority Leader Steny Hoyer, D-Md., said.
The legislation -- a combination of a bill already passed by the Senate and a new measure intended to correct the Senate's perceived excesses -- would result in a reinvention of one-sixth of the American economy.
It would ban insurance companies from discriminating on the basis of pre-existing conditions.
By 2014, it would force most Americans to have health insurance either through their employer or on their own.
Many of those who now don't have insurance would get it either through an expansion of the federal-state Medicaid program or by buying it with a government subsidy.
The newly insured would get their coverage through government-run "exchanges" that aim to make the choice easier and to force competitive pricing.
Democrats trumpeted the bill as the greatest deficit-cutting measure since the 1990s, but the GOP said the complex bill was full of accounting gimmicks that delay some of its most costly elements and mask the bill's real costs.
"It's skewed to look deficit-neutral," said Rep. Chris Lee, R-Clarence. "And I fear that it creates another entitlement the country can't afford."
But the cost analysis added to a sense that the health bill was gaining momentum.
A day after a group of nuns nationwide broke with the Catholic bishops to support the legislation, the AFL-CIO signed on, saying its concerns about a tax on high-end insurance plans in the Senate bill had been allayed by the revisions.
Meanwhile, the GOP lost its attempt to derail the Democratic proposal to fast-track the legislation. That means Democrats are free to use the "Slaughter Solution," whereby the House would "deem" the Senate bill to be approved when it votes to set the terms of debate for the revisions to that measure.
That strategy is named after Rep. Louise M. Slaughter, D-Fairport, who heads the House Rules Committee, which will have to structure the debate on the health care votes now set for Sunday.
Republicans have been attacking Democrats all week over the possible use of the Slaughter Solution, saying it sidesteps normal democratic procedures. But Slaughter and other Democrats said Houses led by both parties have used such procedures dating back to 1933.
"The idea that this is some sort of Byzantine procedure that we've pulled out of a cave is nonsense," Slaughter said.
Republicans railed against the procedure nevertheless.
"The aptly named 'Slaughter Solution' sounds sinister because it is," said Rep. Roy Blunt, R-Mo. "It's a 'hide the ball' effort to prevent members of Congress from casting a yes or no vote for the government takeover of health care."
Liberal Democrats say they favor the Slaughter Solution because it means they will not have to vote directly on the Senate health bill, which includes several unpopular provisions that will be repealed by the health care "reconciliation" bill the House will vote on Sunday.
The House voted 222-203 to reject the GOP attempt to force a direct vote. Siding with Republicans on the issue were 28 Democrats, most of them from conservative districts.
Western New York's lawmakers voted along party lines on the matter and are expected to do the same when the health care bill comes to the floor.
To Rep. Brian Higgins, D-Buffalo, the legislation offers a way to fix a broken system.
Americans paid an average of $7,290 a year for health care in 2007 -- nearly $3,000 more than any other major democracy, the Organization for Economic Cooperation and Development reported. Yet the United States ranked 14th in life expectancy.
"Americans should be indignant and outraged that their health care outcomes are not consistent with what we're paying every single year," Higgins said.
New York got some good news in the details unveiled Thursday. While expanding Medicaid, the state-federal health program for the poor, the plan would cut the state's costs for covering poor nonpregnant childless adults by 50 percent in 2014, moving up to a 90 percent cut by 2018.
"While we are still completing our analysis, this improved legislation appears to eliminate the $1 billion in annual state budget costs projected in the prior proposal," Gov. David A. Paterson said as he urged lawmakers to pass the bill.
Those details were included in the reconciliation package that aims to make the Senate bill palatable to House members. The Senate will have to approve the reconciliation package if the House passes it.
The arcane reconciliation process requires only a 51-vote majority in the Senate to pass, rather than the 60-vote supermajority that is now needed on most major legislation.
But because reconciliation can be used only on budget-related items, Obama's plan for a watchdog agency to roll back huge health premium increases could not be included in the package, House staffers said.
News wire services contributed to this report.
The health care at a glance:
COST: $940 billion over 10 years.
WHO'S COVERED: 32 million uninsured, starting in 2014.
MANDATE: Almost everyone would be required to be insured or pay a fine. Federal subsidies would help many obtain insurance.
EMPLOYERS: Mid-sized and large companies would have to either offer insurance to employees or pay a stiff government fee.
DISCRIMINATION: Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Higher premiums for women would be banned.
MEDICAID: The federal-state Medicaid insurance program for the poor would be expanded to cover people with incomes up to 133 percent of the federal poverty level.
MEDICARE: Subsidies to Medicare Advantage providers would be frozen in 2011 and cut in 2012.
PRESCRIPTIONS: The coverage gap in the Medicare prescription drug benefit for seniors would be closed gradually.
TAXES: A tax on high-cost insurance plans would be dramatically scaled back and delayed until 2018. To recoup lost revenue, the bill applies an increased Medicare payroll tax to investment income as well as wages for individuals making more than $200,000, and couples above $250,000.
PUBLIC OPTION: Not included.
Source: Associated Press, House Rules Committee.