House health care bill set for vote

(Published in The Press of Atlantic City on Friday, Nov. 6, 2009.)

Susan Lord says it was bad enough when the failing economy forced her out of her commercial real estate job.

When the Northfield resident heard about the latest health care reform proposal due for a vote in the House this weekend, she knew it was time to head to Washington to protest what she saw as yet another government program that would inevitably fail.

“Not one of them have worked,” Lord told The Press of Atlantic City on Thursday while protesting alongside Hammonton nurse Mary DeMarco in front of the Capitol. “So why should we give them one-sixth of our economy?”

Lord and DeMarco joined thousands of protesters in Washington who demanded and chanted for Congress to “Kill the bill,” a reference to HR 3962, the health care overhaul legislation that is now more than 2,000 pages long.

But while the critics marched, supporters gathered behind the 10-year, $1.2 trillion bill, on which a vote is expected Saturday. Democrats secured two key endorsements for the bill Thursday, with the American Medical Association and AARP backing its passage.

“We are closer to passing this reform than ever before,” President Barack Obama said. “Now that the doctors and medical professionals of America are standing with us, now that the organizations charged with looking out for the interests of seniors are standing with us, we are even closer.”

House Majority Leader Steny Hoyer, D-Md., said leaders expect to have the 218 votes needed to pass the bill, which would extend coverage to tens of millions of uninsured people and ban insurance companies from turning people away.

“I wouldn’t refer to it as a squeaker, but I think it’s going to be close,” Hoyer said. “This is a huge undertaking.”

Some Democrats in conservative districts, such as U.S. Rep. John Adler, D-3rd, have expressed hesitation with prior versions of the bill and have yet to publicly take positions on the latest version, which was introduced Oct. 29. If Democrats such as Adler do not back it, House Democratic leaders will need to sway moderate Republicans in order to secure enough votes.

U.S. Rep. Frank LoBiondo, a Republican with one of the most nonpartisan voting records in the House, will not be one of them. LoBiondo said Thursday he will vote against the legislation because it would force individuals to pay for health insurance coverage or pay the government for it. The bill includes language requiring people to obtain health insurance coverage or pay the government 2.5 percent of their income that would be taken out of paychecks, although it allows for hardship exemptions.

“This bill is now saying you don’t have a choice,” said LoBiondo, R-2nd. “You’re either going to pay for health care, or you’ll pay a penalty.”

One of the bill’s authors says people are paying a penalty already, just in different ways. U.S. Rep. Rob Andrews, D-1st, one of six co-sponsors on the bill, gave the example of an uninsured person who gets into a serious car wreck. New Jersey hospitals are required by law to care for that person under what is called “charity care.” State taxes go toward paying for charity care but still do not come close to covering hospitals’ entire costs.

“Others pay the costs of that person’s unwillingness to get health care coverage,” Andrews said.

The bill’s other major tenets, according to the Congressional Budget Office and congressional sources, include:

Requiring businesses with payrolls in excess of $500,000 to pay for employees’ health insurance coverage or pay a fee of 8 percent of their payrolls;

Cap out-of-pocket expenses at $5,000 annually for individuals and $10,000 annually for families;

Create a “Health Insurance Exchange” in which people can shop for insurance, including a government insurance option;

Allow people to keep their current plans, at least temporarily (whether they can do so permanently is disputed by the plan’s critics);

Increase the number of primary care physicians and funding for community health centers;

Increase coverage for preventive care, such as mammograms, colon exams, child checkups and nutrition.

An Oct. 29 analysis by the Congressional Budget Office found the bill would have a net cost of $894 billion over 10 years but would cut the federal deficit by $104 billion because various spending cuts and revenue increases would outpace the cost of the plan.

“One of the reasons our economy is suffering is we’re not competing with other countries on health care costs,” Andrews said. “Our health care is too expensive in this country, and it’s costing us jobs.”

But since that initial estimate, the cost has been revised upward to $1.2 trillion because of the inclusion of about $300 billion in costs for an accompanying Medicare physician reform bill that would be considered later, Republicans say.

That’s in part why LoBiondo is not sold on the bill. While he likes some of the plan’s components, such as bolstering the number of primary care doctors and community health centers, he thinks Democrats are “cooking the numbers” on costs and trying to sneak through a long-term transition to an all-public health care system.

For example, LoBiondo points to the 8 percent fee that business owners can pay instead of paying for their employees’ health care coverage. In many cases, that fee would be smaller than what it costs for health insurance, giving employers an incentive to drop their coverage for employees and point them toward the public insurance option, LoBiondo said. Andrews said he would like the 8 percent figure to be higher — 10 percent, perhaps — but does not think many employers would drop that coverage because it would cost them employees and make them less competitive in hiring.

Despite support from the AMA, the medical community is not unified behind the bill. For example, the New Jersey Hospital Association has looked at it very warily because it will cost New Jersey hospitals nearly $4 billion over the next decade, according to Sean Hopkins, the NJHA’s senior vice president for health economics.

Andrews said that assessment is simply wrong.

If the bill passes, it is unclear how soon a vote would come in the Senate, where senators await a cost analysis from the Congressional Budget Office on legislation written by several senators, including Senate Majority Leader Harry Reid.

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The Associated Press contributed to this report.

(Ed. note: The AP contributed the quotes from Obama and Hoyer.)