WASHINGTON-The Democrats got their decades long healthcare wish Sunday night with a key assist from a voting bloc of pro-life Democrats. Now the question of whether this vote ends up being an electoral death wish for the party will have to wait until November.
After a nearly 11-hour day, the House approved the Senate-passed healthcare bill on a 219-212 vote Sunday with just 34 Democrats joining all Republicans in opposition to one of the most sweeping pieces of social legislation in the nation's history. The measure now goes to the desk of President Barack Obama, who is expected to sign it into law this week.
In this healthcare climax, abortion once again played a crucial role in the yearlong push for expanding the federal government's authority in what amounts to one-sixth of the nation's economy.
Much of the suspense behind Sunday's showdown in the House over the Democrats' $940 billion healthcare bill ended early when pro-life Rep. Bart Stupak, D-Mich., called an afternoon press conference to announce his support for the measure.
Surrounded by about a half-dozen other pro-life Democrats, Stupak said he would no longer oppose the bill after striking a deal with the White House.
Stupak was swayed after Obama agreed to sign an executive order stating the new law will uphold long-standing restrictions on the use of federal funds for abortion services. With this sudden support from pro-life Democrats, the healthcare victory of House Democrats was all but assured.
"There was a principle that meant more to us than anything and that was the sanctity of life," said Stupak, who added he has assurances that the president "will not rip this up tomorrow."
But many pro-life groups quickly questioned the value of such an order and accused Stupak, their one-time hero for forcing strict abortion restrictions in a previous healthcare bill last November, for capitulating from his pro-life stance.
In a statement, the National Right to Life Committee said Democrats issued the order merely for political effect: "The president cannot amend a bill by issuing an order, and the federal courts will enforce what the law says."
Indeed, in 1976, Congress had to pass a law banning the use of federal funds for abortion, called the Hyde Amendment, in response to the Supreme Court's 1973 Roe v. Wade decision legalizing abortion.
House Republican Leader John Boehner argued that the very need for an executive order proves that even Democrats acknowledge that this healthcare bill includes new paths to the federal funding of abortion.
"No executive order or regulation can override a statutory mandate unless Congress passes a law that prohibits federal funding from being used in this manner," Boehner added.
One pro-life Democrat, Rep. Marion Berry of Arkansas, agreed and voted against the bill, saying the legislation and the executive order "do not go far enough" in preventing federal funds from being used for abortions.
Indeed, sections of the drafted executive order clearly state that it will not "impair" authority granted by law and that it does not "create" any "enforceable law."
A majority of pro-life groups argue that the bill fails to prohibit federal funds from going to plans that cover elective abortions, and they worry that its $2.5 billion funding increase for community health centers does not prohibit those centers from using these dollars to offer elective abortions.
Still, with just three votes past the 216 Democrats needed for passage, the last-minute deal with Stupak and a handful of his colleagues clearly put healthcare over the top. Without the late shift among the pro-life Democratic voting bloc, Sunday likely would have had a very different ending.
"It is disappointing to see members of Congress exchange 30 years of pro-life law for a piece of paper from the most pro-abortion president in American history," lamented Mike Pence, R-Ind.
Reprisals for Stupak came quickly: Marjorie Dannenfelser, president of the Susan B. Anthony List Candidate Fund, said her group was revoking its "Defender of Life" award to Stupak, which was to be awarded at its Wednesday night gala.
"Let me be clear: Any representative, including Rep. Stupak, who votes for this healthcare bill can no longer call themselves 'pro-life,'" Dannenfelser said.
In addition to its implications for abortion, the bill's passage begins the final chapter of the Democrats' huge gamble that Americans eventually will accept a federal takeover of healthcare. Hundreds of protestors gathered outside the U.S. Capitol on Sunday seemed to cast doubt on that hope. They chanted, "We will remember," "Kill the bill," and "Vote no. Vote no," as Democratic lawmakers, locked arm-in-arm, made their way from House offices to the Capitol to kick off the day of debate. In the end, Democrats, guarded by Capitol police, brushed by the protestors on their way inside where they then brushed by public polls in voting for a bill that a majority of Americans have continued to oppose.
The 2,309-page bill, posted 72 hours before the vote, cuts $523 billion from Medicare and increases taxes by nearly $650 billion, with many of those taxes falling on the middle-class.
It includes a significant $434 billion expansion of Medicaid that would place an additional 16 million Americans into the government plan, with families making as much as $88,000 now eligible for federal assistance. The Congressional Budget Office estimates that 9 million people will lose their current insurance coverage by 2019 under the current proposal. The CBO also predicts that individual premiums will increase 10 to 13 percent.
To keep its budget estimates artificially low, the bill calls for collecting 10 years of taxes for just six years of benefits-many of its coverage provisions will not take effect until 2014 while its related tax increases are slated to begin right away. With much of the cost pushed outside the 10-year budget window, the bill's real cost over a decade of actual operation could top $3.5 trillion.
"The American people know that you can't create an entirely new government entitlement program without exploding spending and the deficit," explained Rep. Dave Camp, R-Mich.
The bill mandates that individuals buy and employers provide insurance or face fines-provisions that will surely face court challenges for their constitutionality.
"This bill is the mother of all unfunded mandates," said Rep. Paul Ryan, R-Wisc. "This bill is a fiscal Frankenstein."
The yearlong debate and final passage will be marked for its strong partisan divide-rarely has a bill that so drastically changes the American landscape passed with so little bipartisan support.
For example, the Social Security Act of 1935 passed with support from 76 percent of the minority Republicans and 84 percent of House Republicans. Congress created Medicare in 1965 with support from 43 percent of Senate Republicans and 51 percent of House Republicans. But with healthcare, zero Republicans in the House and Senate voted for the final bill.
The attention now shifts to the Senate and its majority leader, Harry Reid of Nevada. While Obama can now sign into law the Senate version of healthcare approved by the House, the Senate must also take up a bill of changes that also passed the House. These changes were necessary to win needed support from House Democrats who oppose elements of the Senate bill.
Senate Republicans have promised that the passage of those changes will not go flawlessly for Democrats. Expect a Senate slugfest: Sen. John Cornyn, R-Tex., told Fox News Sunday that Republicans will offer hundreds of amendments during this week's debate: "We're going to help the American people understand by these amendments what is in the bill and why they are right when they think it's a bad bill."