On Saturday night, history knocked on the door of the U.S. House of Representatives and, by a slim margin, they agreed to answer.

Two-hundred nineteen Democrats and one Republican, two more than the bare minimum needed for passage, voted in favor of the Affordable Health Care for America Act.  (Read Community Catalyst’s updated summary). The vote marked the first time in 100 years of episodic efforts to provide health security to all Americans that a bill cleared the floor in either body of Congress. While there wasn’t a single person who voted for the bill who didn’t have some misgivings about some provision, the sentiment that doing nothing was not a viable option prevailed. The vote, above all, meant this: The process must move forward.

The vote was a do-or-die moment in the struggle for health reform and hundreds of groups responded by flooding the Capitol switchboard with calls. Late endorsements from AARP, the AMA and the Conference of Catholic Bishops were crucial, but dozens of state and local organizations also worked tirelessly to advance the cause of health care justice (See the Speaker’s list of endorsing organizations.) Such grassroots mobilization for health care was necessary to counter the ever-more apocalyptic tone of opponents.

The narrow victory was also a testament to the negotiating and vote-counting skills of Speaker Pelosi and Majority Leader Hoyer. Brand new Congressmen Garamendi (D-CA) and Owens (D-CA), winners of special elections only a few days ago and sworn in on Friday, provided the margin of victory. The lone Republican supporter of the bill, Rep. Ahn Cao, who won his seat in 2008 in a heavily Democratic and African American district in Louisiana against an incumbent tainted by corruption charges, provided additional (very thin) cushion.

Wedge issues threaten passage Abortion and immigration, two emotionally-charged issues that expose deep fault lines in the American body-politic, almost derailed the reform legislation at the eleventh hour. Abortion opponents were able to force a vote on an amendment sponsored by Michigan Rep. Bart Stupak that bans coverage for abortions in the “public option” or any plan that is eligible for a federal “affordability credit.” Sixty-four Democrats voted yes on the Stupak amendment.

While many supporters of the abortion ban voted no on final passage, 37 of those yes votes (38 counting Republican Cao) were also yes votes on the bill.  It’s likely that some of those who voted for the ban would have voted yes even had the amendment lost, but it’s also clear, given the narrow margin of victory, that there were not enough votes in the House to pass a health reform bill without the restriction. The amendment was a bitter pill for pro-choice forces both in and out of Congress who nevertheless supported the bill this time in order to move the process forward.

Up until almost the last minute, organizations and members of Congress supporting equity for immigrants were bracing for a fight over a proposal to bar undocumented immigrants from purchasing health insurance through the Exchange even if they used their own money—a provision supported by the White House and included in the Senate Finance bill.  Though members of the Congressional Hispanic Caucus secured a commitment from House leadership not to include provision in the Democratic bill, there was concern that Republicans would offer the language as part of their “motion to recommit,” which does not need to be vetted by the Rules committee prior to its introduction.  Ultimately, the Republican recommittal motion focused on malpractice reform instead.

House action is far from the final word on either of these hot button issues. Both are certain to remain lightning rods during the Senate debate and conference committee deliberations.

Thank you notes

Passage of House bill provides an enormous boost of momentum to the reform effort.  Thank you for your role in this historic vote.  We know many of you reached out to your Representatives, and your voices were heard.  We appreciate your efforts to reform our heath care system.

Before activists turn their attention to the difficult job of winning passage in the Senate, one more critical task remains on the House side. It’s time to thank the members of Congress who labored for months to bring us to this point, who overcame reservations and disappointments with the bill to move the process forward, and who stood up to blistering attacks of distortion and fear-mongering to achieve this unprecedented victory.

It’s also important to thank Congressional staffers, who have been working unbelievably long hours and whose vital role in keeping elected members connected with the concerns of their constituents often goes unseen by the public.

–Michael Miller, Director of Strategic Policy