After the House and Senate both passed their respective health care reform bills, the two chambers had intended to reconcile those two bills into a final package. After the House and Senate passed that final package, it would have been sent to President Obama, who would have signed it into law. Sen. Scott Brown (R-MA), however, won a special election to replace the late Sen. Ted Kennedy (D-MA) before the final health care bill could be brought up for a vote. Brown's victory gave Republicans 41 votes in the Senate, thus depriving Democrats of the 60-vote majority they needed to defeat a Republican filibuster against the final health care bill.
In order to pass comprehensive health care legislation without a 60-vote majority in the Senate, 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.
The House had already passed the companion bill on March 21, 2010. The Senate then made a number technical changes to the measure, and sent it back to the House. Senate Republicans succeeded in striking a number of sections of the bill that did not conform to budget reconciliation rules. These modifications did not change the substance or cost of the bill, but merely forced the House to vote on it a second time.
This was the vote on final passage of 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 have access to health insurance 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. Robert Andrews (D-NJ) urged passage of the bill: "We will finally say that Americans who wait on tables and pump gas and clean our offices at night will finally have the ability to go home and not only thank God for the fact that their child is better but be thankful for the fact that they live in this country where every American finally has affordable access to health insurance. That is our mission here tonight."
Rep. George Miller (D-CA) said: "I rise today in support of this legislation, the last leg of a long journey to bring historic health insurance and student loan reforms to the American people. Two days ago President Obama made our first piece of groundbreaking health reforms the law of the land, a remarkable moment that will benefit millions of American families and small businesses. Our health insurance reforms and student loan reforms are truly historic. But the benefits for Americans start right now. And with this law, we make college more affordable and health care available to all Americans. That's what we promised we would do, and that's what we did."
Rep. Mike Pence argued the Democratic-backed health care overhaul would prove disastrous: "Last Sunday, defying the will of a majority of the American people, House Democrats rammed their health care bill through the Congress…Now we're being asked to fix the bill by passing some sort of reconciliation measure. But, Mr. Speaker, the bill before us tonight doesn't fix anything. It doesn't fix the fact that this is a government takeover of health care that's going to mandate that every American buy health insurance whether they want it or need it or not….Mr. Speaker, the American people know there's no fix for ObamaCare."
Rep. Michael Conaway (R-TX) argued the bill was an assault on freedom: "…Today may well mark a great victory for President Obama and the Democratic Leadership of Congress….it appears as though they finally have the votes to bend an unyielding electorate to their will and pass the most massive expansion of the federal government in two generations. Yet, a victory today would be a pyrrhic victory; the costs of implementing their vision for the future of American health care will bankrupt our treasury and rob us of our liberty."
The House passed the companion reconciliation bill by a vote of 220-207. 220 Democrats -- including all of the most progressive members -- voted "yea." 175 Republicans and 32 Democrats voted "nay." As a result, the House passed legislation (thus, enabling President Obama to sign it into law) 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.).