WASHINGTON — House Democrats rolled out landmark legislation Thursday to extend health care to tens of millions who lack coverage, impose sweeping new restrictions on the insurance industry and create a government-run option to compete with private insurers.
House Speaker Nancy Pelosi announced the 10-year, $894 billion package on the Capitol steps. "Leaders of all political parties, starting over a century ago with President Theodore Roosevelt, have called and fought for health care reform and health insurance reform," Pelosi said. "Today we are about to deliver on the promise."
The measure "covers 96 percent of all Americans, and it puts affordable coverage in reach for millions of uninsured and underinsured families, lowering health care costs for all of us," said Pelosi, D-Calif.
House Minority Leader John Boehner, R-Ohio, mocked the bill's 1,990 pages as 620 pages longer than President Bill Clinton's failed reform plan 15 years ago. The conservative Republican Study Committee warned of "higher taxes, job-killing employer mandates, choice-restricting individual mandates, government-run insurance, budget-busting entitlement expansions and countless provisions that set Washington bureaucrats firmly between you and your doctor."
The nonpartisan Congressional Budget Office says the bill's cost over 10 years is $1.055 trillion. The net cost is $894 billion, factoring in penalties by individuals and employers who don't comply with new requirements. Those figures leave out a variety of new costs in the bill, so there is no official estimate on the total cost.
Pelosi said the legislation would reduce federal deficits over the next decade by $104 billion, and congressional budget experts said it would probably reduce them even further over the following 10 years.
The House bill is similar to its Senate counterpart, but a handful of key differences could make for protracted negotiations later this year. For example, the House's surtax on those earning more than $500,000 per year is a nonstarter in the Senate. Yet House Democrats oppose the Senate's main revenue measure, an excise tax on high value, or "Cadillac," health insurance plans. And while both bills include a government insurance plan, the Senate version would allow states to opt out of participating.
Under the House bill, 36 million uninsured Americans without access to affordable health benefits at work would become eligible for coverage. About 15 million of the poorest children and adults would enroll in Medicaid. Another 21 million would purchase coverage on a national insurance exchange, where private plans would compete with a "public option" backed by the federal government.
An analysis of the House bill released late Thursday by the Congressional Budget Office estimated that just 6 million people would choose a public plan, making it a relatively small player, despite the issue's outsize role in the health care debate.
The House bill would require most individuals to purchase insurance and would require employers to provide health coverage to their workers or face a penalty, although firms with payrolls below $500,000 annually would be exempt.
For weeks, House Democratic leaders have huddled behind closed doors, seeking to stitch together a 218-vote majority from disparate Democratic blocs. Up to 40 conservative Democrats remain unhappy with abortion-related provisions, and are still threatening to vote no. But with a debate on the House floor expected to begin late next week, most major differences appear to have been bridged.
Information from the Washington Post and the Associated Press was used in this report.