March 29th, 2010
10:57 PM ET
13 years ago

Obama to enact changes to new health care bill

WASHINGTON (CNN) - President Barack Obama is set to claim final victory on his top domestic priority Tuesday by signing into law a package of changes to the newly enacted health care reform bill.

The signing ceremony at a community college in northern Virginia will culminate almost a year of fiercely partisan debate and a tortuous legislative journey on the proposals generated by Democrats and unanimously opposed by Republicans.

Due to a shifting political landscape, Democrats eventually needed the separate bill being signed Tuesday to make changes in the original legislation in order to get the overall package passed by Congress.

Among other things, the so-called "fixes" bill significantly expands health insurance subsidies for lower- and middle-income families while watering down a tax on expensive health policies.

The bill also increases the overall cost of the health care reform legislation to $940 billion over the next 10 years, $65 billion more than the original health care bill Obama signed into law last week.

In addition, it overhauls the national college student loan system by shifting government funding for loans away from commercial banks to new education initiatives. Until now, commercial banks have received federal subsidies to provide student loans.

The "fixes" bill received final legislative approval last Thursday in a 220-207 vote in the House of Representatives. No Republicans backed the measure, which GOP leaders insist will lead to cuts in critical Medicare services while doing little to slow spiraling medical costs. Earlier in the day, the Senate approved the plan on a 56-43 vote, also without any Republican support.

The congressional wrangling, which included late night votes and acerbic floor debate, reflected the political split throughout the country over health care reform. Polls show the American public remains sharply divided over the issue, and conservative activists cheered on by Republicans continue to hold rallies against the legislation.

Senate Minority Leader Mitch McConnell, R-Kentucky, recently told CNN that Republicans would use the slogan "repeal and replace" with regard to the health care legislation in their congressional campaigns later this year.

While a repeal of the legislation is considered unlikely, House Speaker Nancy Pelosi, D-California, questioned the strategy by her opponents, noting it would require GOP candidates to favor ending popular benefits in the legislation - such as preventing insurance companies from denying coverage due to pre-existing medical conditions.

"They want to reverse and repeal a prohibition on denying care on the basis of a pre-existing condition," Pelosi said Monday. "Can you imagine making that case?"

Democrats argue the health care reform plan, estimated to extend coverage to 32 million Americans, will reduce future federal budget deficits while giving consumers greater leverage with private insurance companies.

"It's about protecting the middle class so that they can continue to afford the insurance they may like," or purchase desired coverage at a lower cost due to increased competition, Pelosi said.

Throughout the congressional debate, Republicans used every parliamentary tool available to try to undermine both the overall health care bill and the "fixes" measure.

Last week, they forced the Senate to begin deliberations on a series of proposed amendments and motions on the "fixes" bill. All were defeated, but they were intended to force Democrats to cast unpopular votes in the run-up to November's midterm elections.

Initially, it appeared that Congress would pass a compromise health care bill when both the House and Senate approved their own versions last year.

However, the political landscape shifted in February when Republican Scott Brown won a special election in Massachusetts to fill the Senate seat formerly held by Democrat Edward Kennedy, the longtime champion of health care reform who died last year.

Brown's victory cost Senate Democrats the 60-seat majority they needed to overcome a Republican filibuster against a compromise health care bill. In response, Democrats devised a two-bill process in which the House passed the Senate version unchanged, making it law when signed last week by Obama, and also passed the accompanying "fixes" bill to change provisions in the Senate legislation that some House members found unpalatable.

The "fixes" bill was then proposed under reconciliation rules in the Senate that apply to bills involving the budget. Such bills need only a simple majority of 51 votes to pass.

Specific provisions in the "fixes" bill include:

- Closing the Medicare prescription drug "doughnut hole" by 2020. Under current law, Medicare stops covering drug costs after a plan and beneficiary have spent more than $2,830 on prescription drugs. It starts paying again after an individual's out-of-pocket expenses exceed $4,550. Senior citizens stuck in the doughnut hole this year will receive a $250 rebate.
- Raising the threshold for imposing the so-called "Cadillac" tax on expensive health insurance plans to coverage valued at more than $10,200 for individuals and $27,500 for families. The tax won't kick in until 2018.
- Imposing an additional 3.8 percent Medicare payroll tax on investment income for individuals making more than $200,000 a year and couples making more than $250,000 a year.
- Eliminating a special exemption for the state of Nebraska from all new Medicaid expenses - known as the "Cornhusker Kickback." The federal government will instead assist every state by picking up 100 percent of the costs of expanded Medicaid coverage between 2014 and 2016, and 90 percent starting in 2020.
- Reducing the fine for individuals who fail to purchase coverage from $750 to $695.
- Increasing the fine on large companies failing to provide health coverage for workers from $750 to $2,000 per employee.

- CNN's Alan Silverleib and Tom Cohen contributed to this story

Filed under: Health care • President Obama • Reconciliation
soundoff (30 Responses)
  1. Four and The Door

    The bill also increases the overall cost of the health care reform legislation to $940 billion over the next 10 years, $65 billion more than the original health care bill Obama signed into law last week.
    This is Obama's version of 'fixing' health care. Make it even more expensive for the average American taxpayer. As if it wasn't expensive enough to begin with.

    I don't know what problem he is trying to solve, but it's not helping lower health care costs and it's not creating more jobs or helping the economy. This is very clearly an administration that is out of touch.

    March 29, 2010 11:06 pm at 11:06 pm |
  2. recoveringdemocrat

    another step in the evolution of the world's newest communist nation.

    Yep that's us.

    take care comrades....yeee....

    March 29, 2010 11:07 pm at 11:07 pm |
  3. B Obama

    Whats a few billion? You all will obey.

    March 29, 2010 11:09 pm at 11:09 pm |
  4. frank in valparaiso indiana

    Make it a 20% Medicare tax. those SOBs have had enough of a free ride since Reagan.

    March 29, 2010 11:15 pm at 11:15 pm |
  5. Terry - Indiana

    Thank you Mr. President.

    March 29, 2010 11:18 pm at 11:18 pm |
  6. FL

    Oboma needs a giant bottle of white-out. The bill will cost us more than you know. Its like buying a new car after you lost your job. Good idea wrong time. Health care is expensive but get the government involved and it becomes very very very expensive and the quality drops. Ask a Veteran how they like the their care. SLOW, INCOMPLETE, AND GENERIC. You can like the president if you must but nothing is free. It has not worked in any country. We can't afford this bill. The working class are the ones paying for it not oboma or his party of elite. More money out of your pocket for less care. NOT SMART.

    March 29, 2010 11:20 pm at 11:20 pm |
  7. Sandra South Carolina

    Thank you President Obama. We are so proud of your leadership on all fronts. We will remember this entire process when November elections come. We will remember the "NO' Republican block.

    March 29, 2010 11:24 pm at 11:24 pm |
  8. Anthony

    Thank You Mr President. Keep Going!!!! We are with you.

    March 29, 2010 11:25 pm at 11:25 pm |
  9. Vigla

    Fact is, this bill is a good first step. Of course, I prefer Medicare for all. Who needs greedy insurance companies who are just as inefficient as any public entity? This is an example where private companies are just as bad or WORSE than a government entitlement... Teabaggers/Conservatives, anything that will REDUCE the deficit over the long run should be a good thing. Not a bad one. Tax cuts for the rich? Increased the deficit. Why aren't you asking that those tax cuts be repealed?

    March 29, 2010 11:33 pm at 11:33 pm |
  10. Jim

    Obama's signing of this reform is a great milestone for America! Similar to Roosevelt's signing of Social Security, and Johnson's signing of Medicare.

    In the Big Picture, I see four long-term benefits of this reform: 1) healthier, more productive workers and families, 2) increased focus on preventive and results-oriented healthcare, 3) a stronger economy, as overall healthcare delivery costs are brought down, and 4) a stronger nation, with all Americans sharing responsibilities and benefits.

    March 29, 2010 11:39 pm at 11:39 pm |
  11. j

    Now the Democrats just need to get the single-payer and public option passed.

    March 29, 2010 11:40 pm at 11:40 pm |
  12. JP

    How much more will the bill cost us when Obama makes all the illegals citizens like he promised.

    March 29, 2010 11:42 pm at 11:42 pm |
  13. phoenix86

    Obama is "fixing" the fractured system by breaking it. It is like amputating an arm because it is broken.

    The only thing that really needs fixing is the government. And that will be fixed in November of this year and 2012.

    Liberals need pyschiatric help if they believe that the bill just passed will do anything beyond increasing the deficit and damaging the economy.

    March 29, 2010 11:45 pm at 11:45 pm |
  14. A. Smith, Oregon

    Congratulations to the Democratic party, Democratic Congress persons and Democratic US Senators for getting this thru, despite no help from the Republican lawmakers and the Republican lawmakers repeated obstruction tactics.

    I hope President Obama uses this momentum to work and pass sweeping Bank Regulation laws, Infra-Structure Funding and a comprehensive Cap and Trade laws on Big Oil American corporations.

    March 29, 2010 11:47 pm at 11:47 pm |
  15. Average American

    With over 2700 pages, and they still have to make changes, after a year of trying to get it passed. What kind of idiots put this monstrosity, counrty destroying legislation togather?

    March 29, 2010 11:48 pm at 11:48 pm |
  16. Michael from Ventura

    Nice to have a President working FOR the American people instead of AGAINST us! That's a CHANGE I believe in!! Yes we can beats Hell no you don't any day of the week. When the baggers ask how this "hopey-changey-thing" is working for me I say GREAT – thanks for asking.

    March 29, 2010 11:48 pm at 11:48 pm |
  17. Joe

    Is anyone suprised that this bill's cost has already increased – in less than a week? Does anyone expect that this trend won't continue? Washington can't run control the costs of Social Security, can't control the costs of Medicare/Medicaid, and won't be able to control the costs of Health Care because they cannot stop spending our money. The worst recession since the Great Depression won't even stop our politicians from spending our money.

    March 30, 2010 12:12 am at 12:12 am |
  18. jane

    The President and the Democratic Congress are doing exactly what they were elected to do. That the Republicans are screaming so loud, cooking up tea parties, inciting the lunatic fringe and trying to manipulate public opinion to think that this health care reform bill is a bad thing is worse than unpatriotic. It's evil!

    Our Democratic elected officials have done a great thing for the country. Thank you.

    March 30, 2010 12:16 am at 12:16 am |
  19. Obama the Marxist Liar

    one of the 'fixes' was by Pelosi dumping the 'botox tax' ,but keeping the tan salon tax in. THAT is a big loss for health care for America.

    March 30, 2010 12:20 am at 12:20 am |
  20. In the West

    Thank you Mr. President! The right wingnuts are cr4pping in their pants over this legislative victory and the long-term success of these changes. When armageddon (or was it the rapture...?) doesn't come next week (or next month, or next year), who will ever believe their shrill whines again?

    Thanks to all the democrats for putting their country and its people first (over profit, cronyism and ideology).

    March 30, 2010 12:22 am at 12:22 am |
  21. Moe, NY

    Thank you President Obama, A President/politican who finally made good on their campaign promises. Job well done Mr. President.

    March 30, 2010 01:01 am at 1:01 am |
  22. Darth Vadik, CA

    Squeaky wheel gets the grease, most of the time, but in the Tea Partiers case they are just (in their own words) "uneducated" cry babies,

    I wonder how many of these Tea Partiers tried to run into the hospice and give Terry Schiavo water, or used their kids to do their dirty work?

    Maybe they should go join that Ron Paul revolution, or whatever happened to that.

    Sorry, don't pay attention to me, I'm still thinking about the "racy" club I will go to on Friday night, so my mind is wondering all over the place, maybe I'll meet the GOP bigwigs there, LOL

    March 30, 2010 01:04 am at 1:04 am |
  23. Richard Komi

    The president made it clear that the health care bill will not be perfect but that we need to get something done even if it was something that would be improved upon later.

    March 30, 2010 01:12 am at 1:12 am |
  24. North of South

    Health Care Reform Wow thats Change/Hope all rolled into one.
    Thanks President Obama for all your unending hard work ,dedication seeing this through you are a great leader.
    At last we have a President thats intelligent sees the correct path takes it and never gives up .

    March 30, 2010 02:01 am at 2:01 am |
  25. normajean

    There seem to be people who are specifically worried due to the little we have heard about everyone having to have insurance and buying it if they don't have it, Many people simply don't have money to buy it and I read somehere that this is IF you can afford to buy,otherwise you will be subsidized{helped}. This is so that those who can will be using services that they can afford to pay for.I'm not sure this is true, I read it somewhere and it makes sense to me. Let's not worry until we find out if this is factual.This plan will need work as did Sos.Sec and Medicare , but they worked fine after a little work.It's been many years and a number of administrations trying for this, so let's give it a chance

    March 30, 2010 02:20 am at 2:20 am |
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