History is made: Health care reform bill passes!

Reuters via Yahoo! News: President Barack Obama addresses the nation after the House passed historic health care reform legilsation late Sunday night.Reuters via Yahoo! News: President Barack Obama addresses the nation after the House passed historic health care …When Republican Scott Brown won the Massachusetts U.S. Senate seat held for 46 years by the late Ted Kennedy, you could almost hear the resounding sigh and see shoulders shrugging as Democrats in Washington, D.C. were ready to admit defeat before a vote on health care reform was called. With no clear majority in the Senate, it was game over, according to lots of chattering cable pundits.

But late Sunday night, House Democrats voted 219-212 on a health care bill that would extend coverage to 32 million uninsured Americans, prohibit insurance companies from denying coverage to people with pre-existing medical conditions, and reduce deficits. No Republican representative voted for the bill. President Barack Obama, who decided to dig in and make this a central cause of his administration, to not give up despite pleas to scale back and start over, because "it's the right thing to do," had this to say after the late-night vote:

"This legislation will not fix everything that ails our health care system. But it moves us decisively in the right direction. This is what change looks like."

The vote was made possible by a last-minute compromise on funding for abortions that did not please activists on either side of the abortion debate. The bill aims to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for the abortion procedures. The compromise cleared the way for six anti-abortion Democrats to support the bill.

The final details of the bill still need to be worked out between the Senate and the House, but here's in part what it all means for us.

In the short term:

  • Six months after the legislation goes into effect, many health plans would not be able to place lifetime limits on medical coverage, and health insurance companies will not be able to cancel policies of people who become sick.
  • Children with pre-existing conditions could not be denied coverage
  • Dependent children up to age 26 would be eligible for coverage under their parents' health plans. (Some state rules currently cut off coverage at 18 or 19.)
  • Within three months of a law taking effect, people who have been denied coverage because of a pre-existing condition would be eligible for subsidized coverage through a new high-risk insurance program.
Americans who currently receive coverage through large employers likely will not see much of a difference in the near or long term. But beginning in 2014, the new health care system would reach more Americans through a widened Medicaid program and new state-run insurance exchanges.

  • The exchanges will be designed to offer competitive, consumer-minded online shopping hubs for private insurance for people who cannot obtain coverage through employers.
  • People with pre-existing conditions would no longer be denied insurance.
  • Families with incomes above $250,000 will start paying a 3.8 percent tax on their investment income in 2013 while contributing more to the Medicare program via payroll taxes to help pay for the program. Later, families that opt for more expensive insurance policies would be subject to a tax, as well.
  • More lower-income Americans under the age of 65 would be covered by Medicaid. Most other uninsured people would be required to buy insurance through the state-run insurance exchanges.
  • People with incomes of more than 133 percent of the poverty level but less than 400 percent would be eligible for premium subsidies through the exchanges.
  • Americans who do not obtain health insurance would face federal penalties, starting at $95 or 1 percent of income the first year (2014) and rising to to $695 or 2 percent of income in future years.

The loud public debate over health care will not end with this vote, but it is a momentous thing to see this Congress do what others could not do decade after decade after decade. No one will be 100-percent happy with what is forged at the end of this long process because it is not a perfect bill. There's no way it could be. But it is, as the president says, a move in the right direction to help millions of Americans who are working hard but do not have access to medical care before crisis lands them in our hospital emergency rooms, for which we all end up paying the bill.