History was made last Saturday, November 7, on the House floor. In a close vote, 220-215, the House passed the Affordable Health Care for America Act, H.R. 3962. All but one Republican voted against the bill (the exception, Representative Anh Cao (R-2nd LA)); 39 Democrats voted against the bill.
Arriving at the 218 votes needed for passage was not easy. House leaders were forced to make last-minute concessions in order to ensure the survival of the bill. To appease anti-abortion Democrats, House leaders allowed Representative Bart Stupak (D-MI) to offer an amendment that would ban coverage of abortion in the public plan option and would prohibit anyone receiving a federal subsidy from purchasing a health plan that includes abortion benefits. The amendment was adopted 240-194 with the support of 64 Democrats.  Although angered by the amendment, in the end abortion rights lawmakers voted for final passage.

Immigration was another issue that could have derailed health reform in the House. There was a fear that Republicans, in their motion to recommit (a vote essentially to derail the legislation), would offer an amendment to bar undocumented immigrants from purchasing coverage in the Exchange. The bill currently permits undocumented immigrants to purchase coverage in the Exchange at full cost. However, Republicans instead opted to offer an amendment related to tort reform, which failed. It is unclear whether the bill would have passed had greater immigrant restrictions been added. Key Democratic members had threatened to vote against the bill if such restrictions were included. In the end the bill managed to scrape by with a slim majority.

Numerous groups, including the Coalition on Human Needs, rallied behind passage of the bill (see letter CHN sent to House Members on November 5). H.R. 3962 makes important advances towards guaranteeing affordable, quality coverage for a vast majority of people. (See November 2, 2009 Human Needs Report for a summary of the key provisions in the bill.) Still the bill is not perfect and advocates hope there will be opportunities to make improvements that protect and expand access to coverage moving forward.  Some areas of concern relate to coverage of low-income children and lawfully present immigrants. Children’s advocacy groups are concerned that once the Children’s Health Insurance Program (CHIP) expires in December of 2013 children who will be moved into the Exchange may not receive the same level of benefits and cost-sharing protections as in CHIP. (For a summary of changes to Medicaid and CHIP, as well as other provisions affecting low-income families, see the Center for Children and Families’ summary.) Advocates also hope that the five-year waiting period that currently prevents lawfully present immigrants from enrolling in Medicaid and Medicare will be removed.

Passage of the House health bill has added greater pressure on the Senate to follow suit quickly. There is a possibility that Senate Majority leader Harry Reid (D-NV) will bring a bill to the Senate floor on Monday, November 16, but it will all depend on whether Democrats have the 60 votes necessary to proceed.

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