Obama signs historic health care overhaul into law

WASHINGTON — President Barack Obama on Tuesday signed into law a vast overhaul of the nation’s health care
system, the most sweeping expansion of government social policy in more
than 40 years.

A triumphant Obama heralded what he called “a new
season in America,” saying that the new law finally delivered changes
in health care sought and fought for by generations of Americans.

“Today, after almost a century of trying; today,
after over a year of debate; today, after all the votes have been
tallied, health insurance reform becomes law in the United States of America,” he said to cheers.

The president signed the Patient Protection and Affordable Care Act cheered on by Democratic lawmakers as well as Vicki Kennedy, the widow of the late Sen. Edward Kennedy, D-Mass., who’d made the expansion of health care his life’s work.

Supporters interrupted several times with applause
and campaignlike chants, turning the ceremony into a celebration. Even
before Obama walked in, a group of Democratic women from Congress lined up on the stage to pose for pictures. Others broke into chants of the Obama campaign refrain, “Fired up, ready to go.”

There were no Republicans at the historic signing. Every Republican in Congress voted against the bill, and Republicans protested anew Tuesday that the measure threatened Americans’ freedom.

Outside Washington,
several Republican state attorneys general moved to challenge the
constitutionality of the new law, arguing that its mandate that people
must buy health insurance exceeds federal power.

The bill, passed Dec. 24 by the Senate and Sunday by the House of Representatives,
is designed to provide health insurance by 2019 to 32 million Americans
who lack it now, institute new federal regulation of health insurance
companies — including a mandate that they insure everyone regardless of
prior medical problems — and curb costs.

Despite the fanfare at the White House,
the law was just one step of a grand political bargain that was needed
to get it through the House and to the president’s waiting pen.

Soon after the signing, the Senate took
up the second step, a “reconciliation” plan to amend the law in order
to change the way it would finance the benefits and strip out some of
the deals used to win Senate votes on Christmas Eve, such as the “Cornhusker Kickback” of Medicaid benefits just for Nebraska.

The combined plan would cost an estimated $938 billion over 10 years. Financed by tax increases and cuts in Medicare, it would reduce the federal budget deficit by $143 billion over the decade, according to the nonpartisan Congressional Budget Office.

It’s the broadest move by the federal government to guarantee health care since the creation of Medicare for the elderly in 1965. It exceeds the expansion of Medicare to cover prescription drugs, passed by the Republicans and signed into law by President George W. Bush in 2003.

The Senate was scheduled to begin debate on the reconciliation plan shortly after Obama signed the bill Tuesday.

Republicans suffered a major blow from the Senate parliamentarian late Monday in their effort to derail the second bill.

According to GOP Senate officials, parliamentarian Alan Frumin gave them informal guidance that a key part of their plan to challenge the bill won’t hold up.

Republicans’ best hope of overturning the second step “reconciliation” legislation involved Social Security.
Their thinking went like this: Since the new bill delays an excise tax
on high-end insurance plans until 2018 — it’s due to begin in 2013 in
the Senate bill — that would mean less revenue for Social Security, and thus wouldn’t be permissible under reconciliation rules.

Republicans — and the CBO — think that once the tax
kicks in, employers will offer higher wages in lieu of more insurance
coverage. That would mean more Social Security revenue, since the program’s taxes are based on wages. By delaying the tax, reconciliation would hurt Social Security, Republicans argued. However, the parliamentarian advised them that the tax delay was in order.

Republicans still plan a number of challenges to the
reconciliation bill, and the parliamentarian will offer his advice on
each. The presiding officer, a Democrat, then would rule on each, and
the GOP could try to overturn any ruling. Since Democrats control 59 Senate
seats, however, and only two Democrats have voiced opposition to the
bill thus far, it’s unlikely that Republicans could prevail.

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WHAT THE LEGISLATION DOES

The bill is expected to insure about 32 million more
Americans by 2019, according to the CBO, or 94 percent of eligible
Americans. Currently, about 83 percent are insured.

President Barack Obama’s signature
triggers a series of changes in health care laws almost immediately. By
mid-June, high-risk coverage pools would be available for people who
lack insurance because of pre-existing conditions.

By fall, insurers would be barred from denying
people coverage when they get sick, denying coverage to children with
pre-existing conditions and imposing lifetime caps on coverage. In
addition, after September, people could stay on their parents’ policies
until they turn 26. After Jan. 1, insurers would have
to offer small group and individual plans and would have to spend 80
percent of their premium dollars on medical services. Large group plans
would have to spend at least 85 percent.

The bill would require most people to obtain
coverage, and most employers to offer it, starting in 2014. It would
create exchanges, or marketplaces, in which consumers could shop more
easily for policies.

The reconciliation bill makes several changes to the Senate-drafted measure. In 2013, it would increase the Medicare payroll tax and expand it to dividend, interest and other unearned income for singles who earn more than $200,000 annually and joint filers who make more than $250,000. Starting in 2014, it would increase subsidies for families earning up to 400 percent of poverty level, currently about $88,000 a year.

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