President Obama's ambitious plan to overhaul the nation's healthcare system got a major boost when a pivotal House committee passed a compromise bill Friday night, clearing the way for a floor vote this fall.
The bill was approved 31 to 28, with five Democrats and all of the Republicans on the energy and commerce committee voting against it. Despite the defections, enough liberal and conservative Democrats were able to come together to break the deadlock that had stalled the bill for weeks.
"We are a diverse caucus with many points of view," said committee Chairman Henry A. Waxman (D-Beverly Hills). "We've agreed we need to pull together."
To reach agreement, Waxman earlier this week had accepted conservative lawmakers' demands to limit the bill's price tag to $1 trillion over 10 years, exempt more small businesses from the employer-provided insurance mandate, and reduce the number of low-income people who would qualify for subsidized coverage.
But those changes provoked a backlash among liberals. To win them back, Waxman crafted a compromise that would restore low-income subsidies. The committee also added a major provision that would limit the premium increases that insurers could impose, and another that would let the government negotiate pharmaceutical prices under Medicare's prescription drug program -- a goal long sought by liberals as a way to reduce drug costs. (The idea was bitterly opposed by Republicans when the program was established in 2003, as critics questioned whether the government would secure discounts.)
The bill is designed to provide insurance for the 46 million people in the U.S. who now go without it; to curb healthcare costs; and to make it harder for companies to deny coverage or increase premiums.
"We have a historic opportunity to transform our healthcare system," Rep. Mike Ross (D-Ark.), a leader of the panel's conservative faction, said ahead of the vote.
But Republicans said that despite changes made to address conservative Democrats' concerns, the legislation remained a costly, intrusive expansion of government power over medical care. Conservatives did little more than "pick the color of the lipstick on this pig," said Rep. Mike Rogers (R-Mich.).
The vote came just as House members prepared to leave town for a monthlong recess.
Now Democratic leaders are asking lawmakers to fan out around the country to help Obama sell the plan. They will, among other things, try to counter efforts to portray the bill as a government takeover of medicine and to convince middle-class people that the plan would benefit those who already have insurance.
Every House member was given a card summarizing details of the $1-trillion bill -- including new insurance subsidies for the poor, tax credits for small businesses that provide coverage for their workers, and expanded prescription drug coverage for the elderly.
The legislation also would broaden Medicaid, the federal-state healthcare program, to cover more low-income people. Middle-class workers would receive new subsidies to pay health insurance premiums. And government-sponsored insurance would be available as an alternative to private plans.
"The president of the United States will be out front as the drum major," said House Speaker Nancy Pelosi (D-San Francisco). "We will be the drumbeat across America."
White House Press Secretary Robert Gibbs said that the House committee action was a "big, positive step forward, and gets us even closer to comprehensive healthcare reform."
A key part of the Democrats' strategy, worked out in coordination with the White House, will be to demonize insurance companies for opposing a bill that has been backed by an array of health and consumer groups. Pelosi predicted the industry would conduct a "shock and awe" campaign in the coming weeks to block the bill.
Said Gibbs: "I think many people that believe we need comprehensive healthcare reform think that insurance companies have not lived up to all of their responsibilities -- and that they can do better."
Critics worry that the federally run insurance option would undermine private insurers through cut-rate premiums, putting the health system on a path to being dominated by the government. Republicans on the House panel offered an amendment to drop the public option, but the committee rejected it.
Before approving the bill, however, lawmakers defied Waxman and delivered a major victory for the drug industry by voting to give 12 years of market protection to companies that offer advanced new drugs to combat major diseases like cancer and Parkinson's. Opponents, including the White House, had sought to make generic versions of such drugs available to the public sooner.
Energy and commerce is the third and final House committee to have a hand in shaping the healthcare legislation before it goes to the full House. Versions approved by other panels have included a surtax on wealthy people to help pay for the program, and a requirement that most employers provide health insurance for their workers.
Obama had called for action on a healthcare overhaul before the August recess, but Congress is moving more slowly. In the Senate, a key committee has not reached agreement on its version of the bill.
Still, Friday's House committee vote gives a much-needed shot of momentum to the legislation.
During the August recess, House Democratic leaders will tackle the politically tricky task of blending the three committees' versions of the legislation. Unable to count on many Republican votes, leaders will have to produce a bill that commands broad Democratic support, balancing the concerns of conservatives who think the bill costs too much and liberals who think it does not go far enough.
Rep. Anthony Weiner (D-N.Y.) had offered an amendment that would replace the committee's plan with a more comprehensive government health program known as a "single payer" plan -- an alternative modeled after systems like those in Canada and Britain that is strongly supported by liberal activists. Weiner withdrew the amendment after Democratic leaders promised that his measure would be brought before the full House for a vote.
Noam N. Levey in the Washington Bureau contributed to this report.