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111th Congress, Vote 105; Senate #4872

Health Care and Education Reconciliation Act of 2010

Official Title: An Act to provide for reconciliation pursuant to Title II of the concurrent resolution on the budget for fiscal year 2010 (S. Con. Res. 13).

HR 4872: Health Care and Education Reconciliation Act of 2010
Passed Senate, March 25, 2010, 56-43, 1 not voting

Synopsis: The House bill made changes to the health reform legislation approved by the U.S. Senate on December 24, 2009:

  • Lifting subsidies available to moderate-income Americans, making it easier for them to afford private insurance
  • Raising the Medicare payroll tax that will take effect in 2013 for individuals with adjusted gross income of $200,000 or more ($250,000 for joint returns) by including net investment income in the Medicare taxable base and imposing a 3.8% tax on such income.
  • Revising the provisions regarding penalties to be imposed on individuals who decline to purchase health care coverage by:
    1. lowering the maximum penalty amount from $495 to $325 in 2015 and from $750 to $695 in 2016; and
    2. increasing the penalty rates based on taxpayer household income to 1 percent of taxable income in 2014, 2 percent of taxable income in 2015, and 2.5 percent of taxable income in 2016
  • Revising the provisions regarding penalties to be imposed on employers with 50 or more employees who decline to offer employees health care coverage by:
    1. allowing an exemption for the first 30 employees (including part-time employees) when calculating the penalty; and
    2. lifting the applicable penalty amount per employee to $2,000.
  • Prohibiting all individual and group health plans from placing lifetime limits on the coverage except in cases of fraud. Prohibiting pre-existing condition exclusions for children. (Effective six months following enactment) And, beginning in January 2014, prohibiting individual and group health plans from placing annual limits on the dollar value of coverage
  • Delaying the start of a new tax on high-cost employer sponsored insurance policies to 2018, raising the thresholds at which policies would be hit by the tax to $10,2000 for individual coverage and $27,500 for family plans, and increasing threshold amounts for retirees and employees and high-risk professions.
  • Making changes to close the gap in Medicare prescription drug coverage known as the doughnut hole by
    1. providing a one-time $250 rebate in 2010 to all Medicare part D enrollees who enter the Medicare part D coverage gap (also known as the Medicare donut hole,
    2. delaying until January 1, 2011, the deadline for establishment of a Medicare coverage gap discount program, as well as the effective date of the requirement that a part D drug manufacturer participate in it; and
    3. repealing the increase by $500 in the 2010 standard initial coverage limit and reducing the coinsurance percentage for covered brand-name and generic drugs to 25% by 2020 (thus closing the donut hole with 75% discounts).
  • Clarifying a provision requiring insurers to allow adult children to remain on their parents' insurance policies until their 26th birthday.

Why supporters pushed for this bill

  • Legislators who voted for the bill pointed to a Congressional Budget Office report which concluded that it would reduce the federal budget over the next ten years by $20 billion and – combined with the Senate bill – by $138 billion. The CBO concluded that the bill would also reduce the deficit further after the first ten years. The total cost of the coverage expansions in the bill are estimated at $940 billion over ten years, more than the $875 billion cost of the Senate bill, but less than the president's stated limit of $950 billion.
  • According to the CBO, this historic legislation would cover 32 million uninsured Americans by 2019, 95 percent of the population of the United States excluding unauthorized aliens, up slightly from the Senate bill.

Why opponents tried to stop the bill

On March 25, 2010, House Minority Leader John Boehner was speaking for many opponents of the Reconciliation bill when he declared that it tries to "jam more through the system than the system could handle, leaving us a sloppy mess that the majority of the American people believe should be repealed and replaced …

"And mark my word, we will be back to this bill over and over again in the next 6 months. You all know what's going to happen. We'll be back here to correct the mistakes that we didn't do right the first time because of the rush that we were in to approve this massive spending bill that was hidden from the original bill …

"We'll be back here to appropriate money for a new IRS group of individuals that we're going to need to hire to enforce [the tax hikes in] this law …

"And we'll be back to deal with the unintended, but certainly anticipated, consequences of people losing their health care because this bill makes it too expensive for employers to keep employees on their health plan.

"Several weeks ago, more than 130 economists signed a letter to President Obama warning that the health care bill that was being pushed through Congress would cost Americans jobs, and sadly, we're already seeing evidence that those economists were right

"In just the last 3 days, we've seen the stories. Major employers like Caterpillar and John Deere talking about increases of $250 million in their health care costs. Medical device companies in Massachusetts are talking about thousands of jobs being wiped out. The tourism industry in New Hampshire is facing millions of dollars of fines because it hires seasonal workers.

"We're going to have to come back and fix this bill time and time again in the coming weeks and months to correct all the flaws and all of the mistakes.

"What we should be doing is working together to create a better environment for America's small businesses to invest, to save, and to rehire American workers. But, no, instead we're going to keep coming back here fixing the flaws in this very flawed bill."

03/25/2010 Status: Senate bill passed

More: select a member to see his or her other key health care votes.

Yes (56)
Our pick
D Mark Begich AK
D Barbara Boxer CA
D Dianne Feinstein CA
D Michael Bennet CO
D Mark Udall CO
D Christopher Dodd CT
I Joseph Lieberman CT
D Thomas Carper DE
D Edward Kaufman DE
D Bill Nelson FL
D Daniel Akaka HI
D Daniel Inouye HI
D Thomas Harkin IA
D Roland Burris IL
D Richard Durbin IL
D Evan Bayh IN
D Mary Landrieu LA
D John Kerry MA
D Benjamin Cardin MD
D Barbara Mikulski MD
D Carl Levin MI
D Debbie Stabenow MI
D Alan Franken MN
D Amy Klobuchar MN
D Claire McCaskill MO
D Max Baucus MT
D Jon Tester MT
D Kay Hagan NC
D Kent Conrad ND
D Byron Dorgan ND
D Jeanne Shaheen NH
D Frank Lautenberg NJ
D Robert Menendez NJ
D Jeff Bingaman NM
D Tom Udall NM
D Harry Reid NV
D Kirsten Gillibrand NY
D Charles Schumer NY
D Sherrod Brown OH
D Jeff Merkley OR
D Ron Wyden OR
D Robert Casey PA
D Arlen Specter PA
D John Reed RI
D Sheldon Whitehouse RI
D Tim Johnson SD
D Mark Warner VA
D Jim Webb VA
D Patrick Leahy VT
I Bernard Sanders VT
D Maria Cantwell WA
D Patty Murray WA
D Russell Feingold WI
D Herbert Kohl WI
D Robert Byrd WV
D John Rockefeller WV
No (43)
R Lisa Murkowski AK
R Jefferson Sessions AL
R Richard Shelby AL
D Blanche Lincoln AR
D Mark Pryor AR
R Jon Kyl AZ
R John McCain AZ
R George LeMieux FL
R Saxby Chambliss GA
R Charles Grassley IA
R Michael Crapo ID
R James Risch ID
R Richard Lugar IN
R Samuel Brownback KS
R Pat Roberts KS
R Jim Bunning KY
R Mitch McConnell KY
R David Vitter LA
R Scott Brown MA
R Susan Collins ME
R Olympia Snowe ME
R Christopher Bond MO
R Thad Cochran MS
R Roger Wicker MS
R Richard Burr NC
R Mike Johanns NE
D Ben Nelson NE
R Judd Gregg NH
R John Ensign NV
R George Voinovich OH
R Thomas Coburn OK
R James Inhofe OK
R Jim DeMint SC
R Lindsey Graham SC
R John Thune SD
R Lamar Alexander TN
R Bob Corker TN
R John Cornyn TX
R Kay Hutchison TX
R Robert Bennett UT
R Orrin Hatch UT
R John Barrasso WY
R Michael Enzi WY
Not Voting (1)
R John Isakson GA