Obama preparing to sign historic health bill

WASHINGTON (AP) - President Barack Obama is preparing to sign a transformative health care bill ushering in near-universal medical coverage for the first time in the nation's history - and then hit the road to sell it to a reluctant public.

Obama will travel to Iowa City, Iowa on Thursday, the White House said, as he now turns to seeing a companion bill through the Senate and selling the health care overhaul's benefits on behalf of House members who cast risky votes. It is most likely that he will sign the bill on Tuesday, but plans are not yet final, said a senior administration official, who spoke on condition of anonymity to discuss an as-yet-unannounced strategy.

House Democrats voted 219-212 late Sunday to send the landmark legislation to Obama. The 10-year, $938 billion bill would extend coverage to 32 million uninsured Americans, reduce deficits and ban insurance company practices such as charging more to women and denying coverage to people with pre-existing medical conditions.

"This is what change looks like," Obama said later in televised remarks that stirred memories of his 2008 campaign promise of "change we can believe in."

"We proved that this government - a government of the people and by the people - still works for the people."

Obama's young presidency received a much needed boost from passage of the legislation, which would touch the lives of nearly every American. The battle for the future of the health insurance system - affecting one-sixth of the economy - galvanized Republicans and conservative activists looking ahead to November's midterm elections.

What health care's passage means for you

McCain wants to repeal health care bill

A companion package making a series of changes sought by House Democrats to the larger bill, which already passed the Senate, was approved 220-211. The fix-it bill will now go to the Senate, where debate is expected to begin as early as Tuesday. Senate Democrats hope to approve it unchanged and send it directly to Obama, though Republicans intend to attempt parliamentary objections that could change the bill and require it to go back to the House.

Sen. John McCain said Monday morning that Democrats have not heard the last of the health care debate, and said he was repulsed by "all this euphoria going on."

Appearing on ABC's "Good Morning America," McCain, who was Obama's GOP rival in the 2008 presidential campaign, said that "outside the Beltway, the American people are very angry. They don't like it, and we're going to repeal this."

How many covered: 32 million uninsured. Major coverage expansion begins in 2014. When fully phased in, 95 percent of eligible Americans would have coverage, compared with 83 percent today. Cost: $940 billion over 10 years, according to the Congressional Budget Office. Insurance mandate:: Almost everyone is required to be insured or else pay a fine, which takes effect in 2014. There is an exemption for low-income people. Insurance market reforms: Starting this year, insurers would be forbidden from placing lifetime dollar limits on policies, from denying coverage to children because of pre-existing conditions, and from canceling policies because someone gets sick. Parents would be able to keep older kids on their coverage up to age 26. A new high-risk pool would offer coverage to uninsured people with medical problems until 2014, when the coverage expansion goes into high gear. Major consumer safeguards would also take effect in 2014. Insurers would be prohibited from denying coverage to people with medical problems or charging them more. Insurers could not charge women more. Medicaid: Expands the federal-state Medicaid insurance program for the poor to cover people with incomes up to 133 percent of the federal poverty level, $29,327 a year for a family of four. Childless adults would be covered for the first time, starting in 2014. The federal government would pay 100 percent of costs for covering newly eligible individuals through 2016. If the Senate approves a package of changes this week, a special deal that would have given Nebraska 100 percent federal financing for newly eligible Medicaid recipients in perpetuity would be eliminated. A different, one-time deal negotiated by Democratic Sen. Mary Landrieu for her state, Louisiana, worth as much as $300 million, remains. Taxes: To make up for the lost revenue, the bill applies an increased Medicare payroll tax to the investment income and to the wages of individuals making more than $200,000, or married couples above $250,000. The tax on investment income would be 3.8 percent. If the Senate follows through, it would impose a 40 percent tax on high-cost insurance plans above the threshold of $10,200 for individuals and $27,500 for families. The tax would go into effect in 2018. Prescription drugs: Gradually closes the "doughnut hole" coverage gap in the Medicare prescription drug benefit that seniors fall into once they have spent $2,830. Seniors who hit the gap this year will receive a $250 rebate. Beginning in 2011, seniors in the gap receive a discount on brand name drugs, initially 50 percent off. When the gap is completely eliminated in 2020, seniors will still be responsible for 25 percent of the cost of their medications until Medicare's catastrophic coverage kicks in. Employers: Employers are hit with a fee if the government subsidizes their workers' coverage. The $2,000-per-employee fee would be assessed on the company's entire work force, minus an allowance. Companies with 50 or fewer workers are exempt from the requirement. Part-time workers are included in the calculations, counting two part-timers as one full-time worker. Subsidies: The aid is available on a sliding scale for households making up to four times the federal poverty level, $88,200 for a family of four. Premiums for a family of four making $44,000 would be capped at around 6 percent of income. How you choose: Small businesses, the self-employed and the uninsured could pick a plan offered through new state-based purchasing pools called exchanges, opening for business in 2014. The exchanges would offer the same kind of purchasing power that employees of big companies benefit from. People working for medium-to-large firms would not see major changes. But if they lose their jobs or strike out on their own, they may be eligible for subsidized coverage through the exchange. Government-run plan: No government-run insurance plan. People purchasing coverage through the new insurance exchanges would have the option of signing up for national plans overseen by the federal office that manages the health plans available to members of Congress. Those plans would be private, but one would have to be nonprofit. Abortion: The bill tries to maintain a strict separation between taxpayer dollars and private premiums that would pay for abortion coverage. No health plan would be required to offer coverage for abortion. In plans that do cover abortion, policyholders would have to pay for it separately, and that money would have to be kept in a separate account from taxpayer money. States could ban abortion coverage in plans offered through the exchange. Exceptions would be made for cases of rape, incest and danger to the life of the mother. GOP Ideas: Following a bipartisan health care summit last month, Obama announced he was open to incorporating several Republican ideas into his legislation. But two of the principle ones - hiring investigators to pose as patients and search for fraud at hospitals and increasing spending for medical malpractice reform initiatives - did not make it into the legislation. The legislation incorporates only one, an increase in payments to primary care physicians under Medicaid, an idea mentioned by Sen. Charles Grassley, R-Iowa.

The complicated two-step approval process for the legislation was made necessary because Senate Democrats lost their filibuster-proof supermajority in a special election in January, a setback that caused even some Democratic lawmakers to pronounce the yearlong health care effort dead. Under the relentless prodding of House Speaker Nancy Pelosi, in particular, it was gradually revived, and the fix-it bill will be considered under fast-track Senate rules that don't allow minority party filibusters.

"We will be joining those who established Social Security, Medicare and now, tonight, health care for all Americans," said a jubilant Pelosi, D-Calif., partner to Obama and Senate Majority Leader Harry Reid in the grueling campaign to pass the legislation.

"This is the civil rights act of the 21st century," added Rep. Jim Clyburn of South Carolina, the top-ranking black member of the House.

GOP lawmakers attacked the legislation as everything from a government takeover to the beginning of totalitarianism, and none voted in favor. "Hell no!" Minority Leader John Boehner, R-Ohio, shouted in a fiery speech. "We have failed to listen to America and we have failed to reflect the will of our constituents."

Thirty-four Democrats also voted "no" on the Senate-passed bill.

Sunday night's votes capped an unpredictable and raucous weekend at the capitol, with Democratic leaders negotiating around the clock for the final votes as hundreds of protesters paraded outside, their shouts of "Kill the Bill! Kill the Bill!" audible within the Capitol.

A last-minute deal with a critical group of anti-abortion lawmakers Sunday afternoon sealed Democrats' victory. The leader of the anti-abortion bloc, Rep. Bart Stupak, D-Mich., didn't get to add stricter anti-abortion language to the underlying bill, but was satisfied by an executive order signed by Obama affirming current law and provisions in the legislation that ban federal funding for abortions except in cases of rape, incest or danger to the life of the mother.

Republican abortion foes said Obama's proposed order was insufficient, and when Stupak sought to counter them, a shout of "baby killer" was heard coming from the Republican side of the chamber.

Far beyond the political ramifications - a concern the president repeatedly insisted he paid no mind - were the sweeping changes the bill held in store for Americans, insured or not, as well as the insurance industry and health care providers.

The nonpartisan Congressional Budget Office said the legislation awaiting the president's approval would cut deficits by an estimated $143 billion over a decade. For the first time, most Americans would be required to purchase insurance, and face penalties if they refused. Much of the money in the bill would be devoted to subsidies to help families at incomes of up to $88,000 a year pay their premiums.

The second measure, which House Democrats demanded before agreeing to approve the first, included enough money to close a gap in the Medicare prescription drug coverage over the next decade, starting with an election-season rebate of $250 later this year for seniors facing high costs.

It also included sweeping changes in the student loan program, an administration priority that has been stalled in the Senate for months.

For the president, the events capped an 18-day stretch in which he traveled to four states and lobbied more than 60 wavering lawmakers in person or by phone to secure passage of his signature domestic issue. He also postponed an overseas trip to remain in Washington and push for the bill.

Obama watched the vote in the White House's Roosevelt Room with Vice President Joe Biden and dozens of aides, exchanged high fives with Rahm Emanuel, his chief of staff, and then telephoned Pelosi with congratulations.