In order to pass comprehensive health care reform legislation, 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.
This was the vote on passage of 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 be covered 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. John Spratt (D-SC) argued the reconciliation bill would help provide access to health care for nearly all Americans: "Opponents of health care reform have said anything and done everything to distort the facts, delay the process, and try to put off what Americans have asked for and needed for generations. They have tried to sow fear into the American people….But we have made it to the final step in this process--despite all that noise. And now we face a simple choice. We can side with America's families and college students and make health insurance and college more affordable and accessible--while creating millions of jobs and reducing the deficit. Or, we can side with insurance companies and banks. That's it. That's the choice. I'm siding with the American people. "
Rep. Steve Israel (D-NY) argued the bill would help his struggling middle-class constituents: "They are the average Long Islanders--not rich, not poor, but usually somewhere in between--who live in quiet desperation and concern….The woman who thought health care worked pretty well for her, until her daughter was diagnosed with breast cancer....The middle class family with two kids just out of college who are having trouble finding a job that provides health insurance. Under this bill, those young adults can get coverage on their parents' plans until they turn 26."
Rep. Paul Ryan (R-WI) argued the bill would infringe upon Americans' freedoms: "The philosophy advanced on this floor by this majority today is so paternalistic and so arrogant. It's condescending, and it tramples upon the principles that have made America so exceptional. My friends, we are fast approaching a tipping point where more Americans depend upon the Federal Government than upon themselves for their livelihoods, a point where we, the American people, trade in our commitment and our concern for individual liberties in exchange for government benefits and dependences."
Rep. Mike Pence (R-IN) argued the Democratic majority was ignoring the will of the public: "Despite overwhelming public opposition today, this administration and this Congress is poised to ignore the majority of the American people. Let me say, Mr. Speaker, this is not the President's House. This is not the Democrats' House. This is the people's House, and the American people don't want a government takeover of health care."
The House passed the reconciliation bill by a vote of 220-211. 220 Democrats -- including all of the most progressive members -- voted "yea." All 178 Republicans present and 33 Democrats voted "nay." As a result, the House passed 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.). The legislation then went to the Senate for consideration by that chamber.