What’s Holding Up The House Health Care Vote?

This morning, on a conference call with reporters, House Majority Leader Steny Hoyer (D-MD) warned that “action on a health care overhaul could slip past a planned Saturday evening vote into Sunday — or even Monday or Tuesday — if House Republicans employ delaying tactics.” House Speaker Nancy Pelosi (D-CA) assured reporters yesterday that “we will” have enough votes to pass the House, but press reports indicate Democrats have yet to reach agreement over coverage for undocumented immigrants and abortion.

Yesterday, 20 members of the Hispanic Caucus threatened to vote against a bill that prevented undocumented immigrants from purchasing coverage in the exchange with their own money and it’s unclear if ongoing negotiations have satisfied enough of the 40 pro-life Democrats unhappy with the bill’s restrictions on abortion funding. Reps. Bart Stupak (D-MI) and Brad Ellsworth (D-IN) have offered stronger abortion language that the caucus is currently considering.

Assuming that every Republican votes against the measure, Democrats have to peel away approximately 22 unsatisfied caucus members to pass the bill in the House. President Obama is expected to officially endorse the legislation later today and personally rally support for the measure during a visit to the Capitol on Saturday. Still, major policy disagreements could delay a House vote. Below is a table laying out the areas of disagreement:


Current LawHouse BillStupak AmendmentEllsworth AmendmentAbortion Funding In ExchangeNo Exchange currently exists, but under the Hyde amendment, federal dollars can only be used to pay for abortions when the pregnancy threatens life of mother or results from rape or incest. Federal dollars can only be used for ‘Hyde abortions.’ Only private premiums could be used to pay for abortions beyond Hyde restrictions. Each plan in Exchange will decide whether to cover additional abortion services. At least one plan in each market area must offer abortion services and one plan must not.Public dollars cannot fund an insurance plan that covers abortion, even if the woman pays for the abortion with private premiums. Effectively, no plans in the Exchange would cover abortion services.Public dollars can fund an insurance plan that covers abortion only if the legislation establishes “clear, strict rules for separating public funds from the premiums of private individuals.” Guarantees a pro-life insurance option even if the Hyde Amendment is repealed. Abortion In Public OptionThere is no public option under current law. Abortion services — even those allowed by the Hyde Amendment — cannot be mandated as part of a minimum benefits package, but the public option, like private plans, could chose to cover abortion services. If abortion is offered, it cannot be financed with federal funds.The public option cannot provide abortion coverage.The public option can only provide abortion coverage if it hires “a private contractor to pay abortion providers, thus avoiding direct federal payments.”


Current LawHouse BillWhite House position/Senate BillPossible changesUndocumented immigrants are ineligible for Medicaid or SCHIP. Verification procedures vary from state to state. Legal immigrants must wait 5 years before applying for Medicare/MedicaidUndocumented immigrant are ineligible for government subsidies in the Exchange but could buy coverage with private premiums. Legal immigrants could qualify for tax credits outside of the 5-year waiting period.Undocumented immigrants are ineligible for government subsidies and cannot purchase coverage within the Exchange. Legal immigrants could qualify for tax credits outside of the 5-year waiting period.Stronger verification mechanisms (through the Department of Homeland Security, not just Social Security Administration); inclusion of Senate eligibility language in House bill.


Democrats would also have to defray likely Republican efforts to use the the motion to recommit “as an opportunity to insert a social issue poison pill, likely on abortion or immigration, that would peel off enough moderate Democrats to pass.” Republicans “could craft an abortion measure that gives pro-life Democrats little choice but to vote with the minority to change the bill. That change could make the final bill unpalatable enough for most Dems that its passage would be put in jeopardy,” Politico speculates.


During this afternoon’s Rules Committee hearing, Rep. Louise Slaughter (D-NY) confirmed that bill will move to the floor “tomorrow.”