2010年3月24日水曜日

米医療保険改革成立

米医療保険改革が成立した。
 国民皆保険制度が先進国で唯一ない米国は、企業が従業員に提供する
民間保険か、メディケイド、メディケアが中心。医療費上昇を背景に、
失業で保険を失ったり、個人で加入する余裕のなかったりする無保険者は
約4600万人に上るが、法案は不法入国者を除く全国民に保険加入を事実上
義務づけた。保険加入率は現在の83%から95%に拡大する。

国民皆保険未加入にあたり
・従業員1人当たり年間2千ドルの罰金
・既往症患者の保険適用を拒否禁止

ヒラリーができなかった医療保険改革をオバマは公約どおり成立させた
ようだ。報道にある「リスクをとる価値のある改革」は、恩恵を受けて
みれば理解できるだろう。
CBOが言う「コスト削減の方法が不明瞭」は、富裕層も多いし、所得額も
高いので、公約どおり、富裕層減税の打切りでまかなえると思う。

米医療保険改革は、公聴会と同様に一部の議員には有利に働いた。
Joe Wilson    "You lie!"   200万ドル以上の寄付金増額
Randy Neugebauer "Baby killer!" 中絶助成金の禁止取決め


Health Care: many questions, some answers Wood TV8


---米の“かたち”変える 医療保険改革、100年経て実現---
2010.3.23 10:01
http://www.sankeibiz.jp/macro/news/100323/mcb1003231002031-n1.htm

 【ワシントン=渡辺浩生】米医療保険改革がオバマ政権の約1年の審議と、セオドア・ルーズベルト大統領の提案から100年以上の年月を経て、実現が確実となり、民主党やホワイトハウスは“歴史的偉業”の達成に沸いた。しかし、共和党は全員反対し、国論は二極化したままだ。個人の自由を保障する自己責任を重視してきた米国にとり、事実上の国民皆保険化を図る改革は国のあり方を変える転換点。財政などへの影響も未知数といえる。

◆挫折の連続
 「法案は決定的に国を正しい方向に導く。これこそ変革だ」。オバマ大統領は法案可決を祝福した。
 「先進国で唯一、国民全員が保険に加入する制度がなく、世界でも最も医療コストが高い」(クルーグマン米プリンストン大教授)。米医療保険制度の改革の必要性を否定する声はない。ハーバード大の調査では、無保険が原因となった死者は年間約4万5千人に上る。医療費負担は米企業の競争力をそいでいる。
 それでも、共和党のセオドア・ルーズベルト大統領(1901年就任)が改革を最初に提唱して以来、歴代政権が試みた改革は挫折の連続だった。「福祉国家型の欧州諸国と違って、国に依存することに疑念を持つ米国民の性格も原因となってきた」。米シンクタンク、ブルッキングス研究所のニボラ上級研究員はこう解説する。
 経済危機の最中に就任したオバマ大統領は「危機は大事業の絶好の機会」と考え、医療保険改革を内政上の最優先課題に掲げた。
 しかし、増税で得た財源で無保険者の解消を図る「大きな政府」型の改革を志向する民主党と「高コストにメスを入れるべきだ」とする共和党が基本路線で折り合える余地はなかった。
 負担増を懸念した既存の保険加入者にも法案に反対する声が広がり、オバマ大統領の支持率は50%を下回った。
 中間選挙を控える民主党議員の多くも、不人気な法案の賛否に揺れた。しかし、政治生命をかけた大統領は、アジア歴訪を延期して採決当日まで説得を続けた。

◆討議8時間
 反対派のデモが押し寄せた21日の下院本会議。「個人の独立か、政府の支配か、国の将来の選択だ」(共和党のライアン議員)、「今夜の投票は、全国民に医療保険を保障する未達成の大事業」(民主党のペロシ下院議長)。8時間を超す討議は、国の方向性を問う激論が続いた。
 可決された法案については、議会予算局(CBO)でさえ「コスト削減の方法が不明瞭(めいりょう)」と指摘。支出が予想外に膨らみ「財政破綻(はたん)を招く」(ライアン氏)という危惧(きぐ)は消えていない。
 それでも、「リスクをとる価値のある改革」(ニボラ研究員)という見方も少なくない。
 ブッシュ政権時の保健福祉副長官を務めたハドソン研究所のトロイ上級研究員が「米国は、後戻りできない転換点を過ぎた」と指摘するように、「国の性格に関する論争」(オバマ大統領)の末、実現に踏み出した改革は、米国の“かたち”を変える可能性をも秘めている。


---米国の保険制度 加入率83%→95%に---
2010.3.23 09:36
http://sankei.jp.msn.com/world/america/100323/amr1003230939000-n1.htm

 国民皆保険制度が先進国で唯一ない米国は、企業が従業員に提供する民間保険か、低所得者向け公的医療保険(メディケイド)、高齢者向け公的保険(メディケア)が中心。医療費上昇を背景に、失業で保険を失ったり、個人で加入する余裕のなかったりする無保険者は約4600万人に上るが、法案は不法入国者を除く全国民に保険加入を事実上義務づけた。保険加入率は現在の83%から95%に拡大する。
 法案には従業員に保険を提供しない企業に従業員1人当たり年間2千ドルの罰金を科すことや、既往症が原因で患者の保険の適用を拒否してきた民間保険会社の慣行を禁止することなども盛り込まれた。
 共和党は、市場規制強化で競争が阻害されて、医療費の上昇と財政支出の増大を招き、危機的な財政を悪化させると反対、既存の保険加入者の多くも医療サービス低下や負担増を懸念しており、米NBCテレビなどの最新世論調査では48%が法案を「悪いアイデアだ」と回答。不支持が支持を上回った。


---国民皆保険と富裕層増税---
最終更新:2010年03月23日 08時55分
http://media.yucasee.jp/posts/index/2925

 米下院本会議は21日、国民皆保険制度を目指す医療保険改革法案を賛成多数で可決した。財源として、富裕層に対する増税などが充てられる模様で、219対212という僅差が、世論を二分していることを物語る。
 米国は国民皆保険制度がなく、無保険状態の国民が4000万人以上に達しており、オバマ政権が国内の最重点政策に掲げていた。ただし、大統領選で富裕層減税の打ち切りを公約として宣言。コスト削減などと合わせて6000億ドル以上をねん出するとされている。
 今後は富裕層への増税、企業への負担増という方針が出されており、それが過半数をわずか3票だけ上回る接戦となった。また、与党民主党からも反対票が出たほど。
 結果的に富裕層の足を引っ張ることになるのか。どのような形で富裕層増税がなされるのか。国民皆保険制度と同様に米国にとって大切な決定でもある。


---米医療改革法案を可決、「国民皆保険」実現へ---
2010年3月22日20時15分 読売新聞
http://www.yomiuri.co.jp/world/news/20100322-OYT1T00404.htm

【ワシントン=黒瀬悦成】米下院は21日夜、オバマ大統領が内政上の最重要懸案に掲げていた医療保険制度改革法案を賛成219、反対212の賛成多数で可決した。大統領が近く署名し成立する。法案は、医療保険への加入義務化をうたっており、先進国で唯一、「国民皆保険」制度がなかった米医療保険システムの歴史的な大変革となる。
 法案は、上院が昨年12月に可決したもので、〈1〉国民の保険加入を義務化〈2〉安価な保険提供に向け「保険取引所」を創設〈3〉保険会社が既往症を理由に加入を拒否することを禁止――などが主な内容。この日の下院審議では、同法案に加え、中低所得層への保険料負担軽減策などを盛り込んだ修正案も可決した。修正案が週内にも上院で可決されるのを待って、大統領が署名する。
 アジアなど歴訪を延期して法案可決を働きかけてきた大統領は21日深夜、ホワイトハウスで声明を発表し、「これは米国民の勝利、良識の勝利。これこそが改革だ」と述べた。
 法案は、最大の焦点だった公的医療保険制度の導入は見送る一方、低所得者層向け公的保険(メディケイド)の対象拡大、中低所得者層への減税などによって国民の大半が保険に加入できる措置を講じた。
 米議会予算局の試算では、修正案を含む改革が実現すれば、今後10年間で3200万人が新たに保険に加入し、加入率は現在の83%から95%に上昇する。一方、今後10年間に必要な改革費用は約9400億ドル(約85兆円)に上り、財源には民間の高額保険に加入している世帯への課税や、高齢者向け公的保険(メディケア)支出の削減などを充てる。
 米国では政府による医療保険の管理に抵抗が強く、歴代政権が「皆保険」を目指しながら挫折した経緯がある。各種世論調査によると、国民の半数が今回の改革に反対しており、11月の中間選挙に向け国論を二分した論議が続く見込みだ。


---Abortion foe from Texas says he regrets outburst---
By Paul Kane
Tuesday, March 23, 2010
http://www.washingtonpost.com/wp-dyn/content/article/2010/03/22/AR2010032203575.html

Rep. Randy Neugebauer (R-Tex.) acknowledged Monday that he is the lawmaker who yelled "Baby killer!" as a Democrat and fellow opponent of abortion explained why he would support health-care legislation. Neugebauer stood by his attack on the bill, saying he was representing the people of his district.

Ending a 15-hour mystery regarding who shouted the remark, the three-term representative from the vast counties of northwest Texas said he has apologized to Rep. Bart Stupak (D-Mich.), who was speaking at the time. He said the debate brought out too much passion in his disagreement with the deal Stupak reached with President Obama and congressional leaders over abortion provisions in the legislation.

"In the heat and emotion of the debate, I exclaimed the phrase 'it's a baby killer' in reference to the agreement reached by the Democratic leadership. While I remain heartbroken over the passage of this bill and the tragic consequences it will have for the unborn, I deeply regret that my actions were mistakenly interpreted as a direct reference to Congressman Stupak himself," Neugebauer said in a statement.

Stupak questioned that. "I certainly took it as a personal attack on me," he said in a Fox News interview Monday. He lamented the "uncivilized behavior" during speeches that has surfaced in the past year.

In an interview with Lubbock, Tex., television station KCBD, Neugebauer said he believes that the Senate bill the House approved "is a baby-killing bill. And I don't like the language in that bill; it puts taxpayers, I think, in many ways funding abortions in this country. And even if you're pro-choice or pro-life, I don't think that many Americans think that their tax dollars should be going to fund abortions."

His outburst late Sunday came at the end of a weekend war of words, tense and sometimes ugly, both inside the chamber and outside on the Capitol grounds, and it drew immediate shouts of derision from Democrats, but no Republican claimed the comment. Neugebauer's allies declined to identify him Sunday night.

Democratic aides, growing angry at the silence, linked the comment to some of the heated rhetoric voiced by the thousands of "tea party" protesters who gathered around the Capitol over the weekend, including calls of racist and anti-gay terms at black and gay Democrats.

Neugebauer is an unlikely lawmaker to find the spotlight. Elected in a special election in spring 2003, his highest-level position is as ranking Republican on the Agriculture Committee's livestock, dairy and poultry subcommittee.

The moment served, in some ways, as a symbolic bookend to the infamous "You lie!" shout that came from another little-known Republican, Rep. Joe Wilson (S.C.), during Obama's September address before a joint session of Congress. Although the House admonished him -- Wilson apologized privately to White House Chief of Staff Rahm Emanuel but refused to apologize in the well of the House -- he briefly became a conservative icon, raising more than $2 million in a few weeks in September.

Over the weekend, one chant heard from tea party protesters was "You lie, you lie!"

Some colleagues defended Wilson last fall, noting that his charge was based on a controversial immigration provision in the legislation, but there were no Republicans defending what Neugebauer said.

"I condemn any manner of disrespect and name calling among my colleagues. While I am disappointed in Rep. Stupak's decision to vote for this legislation, I would never attack his character and decisions in such an unacceptable manner," Rep. George Radanovich (R-Calif.), who was seated one row in front of the Texas delegation, said in a Monday statement reiterating his denial that he made the remark.

Rep. John Campbell (R-Calif.), also an initial suspect, quickly renounced the remark as votes were ongoing Sunday night. He told reporters the shout came from someone with a "Southern accent" and noted that the Texas delegation often sits a row behind the Californians.

That Stupak was the target galled the Democrats. His antiabortion views made him a key holdout on the legislation, and he and more than a half-dozen other Democrats backed it only after he secured a deal with Obama to issue an order reaffirming the ban on federal funding for abortions. The lengthy and often public negotiations isolated Stupak within his caucus, as he jeopardized the fate of the legislation. But his colleagues never doubted his Catholic faith and his opposition to abortion.

So, after they had already approved the major piece of health-care legislation on a 219 to 212 vote, Democrats entrusted Stupak with the role of speaking in opposition when the GOP offered its lone amendment to a revisions package -- the Republican amendment being mostly a reiteration of Stupak's own preferred legislative wording to restrict abortions. As he rose to speak, the former state trooper from Michigan's Upper Peninsula received a standing ovation from many of his colleagues.


---GOP Senators Prepare Delaying Tactics for Remaining Healthcare Bill---
Janet Hook and James Oliphant Reporting from Washington
March 22, 2010 | 4:22 p.m.
http://www.latimes.com/news/nationworld/nation/wire/sc-dc-health-what-next22-20100322,0,7769921.story

Even as Congress' long health-care debate nears a close, Republicans in the Senate took to their battle stations Monday for one last round of the no-holds-barred delaying tactics that they have so far used in vain to fight the biggest social policy change in a generation.

In a White House ceremony scheduled for Tuesday, President Obama will sign the nearly $1 trillion healthcare overhaul given final approval by the House Sunday night, then take a victory-lap trip to middle America.

Travelling to Iowa Thursday, Obama kicks off a party-wide effort to sell a still-skeptical public on the benefits of his plan to reduce the ranks of the uninsured, provide more stability and security for those who have insurance, and begin slowing the growth of healthcare costs.

But the Democrats' victory will not be complete until the Senate clears a follow-up bill to put politically sensitive finishing touches on the blueprint - changes that House Democrats considers essential to improving the bill they passes Sunday, which was designed and passed by the Senate late last year.

Senate Democrats hope to approve and send the bill embodying the changes to the White House by the end of the week, then step up their drive to counter Republicans' portrayal of the bill as a government takeover of health care, financed with big tax hikes and laden with special interest provisions.

But Republicans are planning to deploy parliamentary maneuvers and offer a cascade of amendments in an effort to drag out debate. Since the packages of changes is contained in a so-called budget reconciliation bill and not subject to filibuster, the only question is how long the process will last.

Democrats believe the stalling tactics will help reinforce the GOP's image as the ``Party of No,'' while many Republicans are happy to embrace that label.

"No more tax hikes; no more Medicare cuts; no more deal making,'' said Senate Republican Leader Mitch McConnell (R-Ky.) Monday. ``Democrats may have won their vote last night (in the House) but they lost the argument.''

The health care argument will be a central part of the 2010 midterm campaign as leading Republicans have already begun calling for repeal of Obama's policy.

"This bill is terribly wrong for America and I call on you to join with me to challenge this bill in every way we can,'' said a fundraising letter from Sen. John McCain (R-Ariz.), who is up for reelection in 2010 and facing a conservative GOP primary opponent.

"I assure you I am not quitting our fight. I believe we must repeal this bill immediately," he said.

Democrats believe they will score a crucial election-year accomplishment Tuesday when Obama signs the sweeping healthcare legislation. It includes the major pillars of change he sought: an expansion Medicaid eligibility, regulations to make it harder for insurance companies to cut off policies or deny benefits; a new insurance exchange to make it easier for individuals and small businesses to buy affordable policies; and insurance premium subsidies for families of modest means.

To help cover the roughly $900 billion 10-year cost of expanding insurance coverage and subsidies, the bill also imposes a new excise tax on expensive health plans, curbs costs in Medicare and increases payroll taxes on upper income people.

To make that Senate bill more to their liking, House Democrats also passed the separate reconciliation bill that eliminates such provisions as a special Medicaid loophole for Nebraska. The follow-up bill also limits the scope of the excise tax, increases premium subsidies and expands prescription-drug coverage for the elderly.

The reconciliation bill comes before the Senate Tuesday under special rules that provide only 20 hours of debate, but allows unlimited amendments at the end of the allotted time.

It is not clear how much appetite Republicans will have for limitless amendments that threaten their ability to return home. Conservatives like Sens. Tom Coburn (R-Okla.) and Jim DeMint (R-S.C.) have threatened a limitless onslaught, but other Republicans may have second thoughts about high-profile delaying tactics. A senior GOP strategist said most senators probably lack the stamina to drag the process into the weekend.

Democrats will try to block every amendment - even small, politically appealing ones - because any change would force them to send the bill back to the House. The two chambers must approve identical bills.

GOP leaders will try to challenge the entire bill and key parts on procedural grounds - technicalities that will be mediated by the Senate parliamentarian, Alan Frumin. If Frumin's advice leads to a provision being struck, it would take a 60 vote majority to overrule it - an unlikely prospect.

Republicans also are expected to offer amendments designed to force Democrats to take politically awkward votes. For example, they could propose adding a government insurance program - the "public option" that most Democrats support but was dropped to the dismay of their liberal base.

Democrats were already trying to discredit GOP opposition to the bill by linking it to the angry outbursts that marked the House's two-day weekend debate as some demonstrators who swarmed Capitol Hill and threw bigoted invectives at black and gay Democratic lawmakers and some Republicans echoed the crowd's ``Kill the Bill'' chants from the Capitol balcony.

House Minority Leader John Boehner (R-Ohio) denounced the racists comments as ``reprehensible,'' but many House Republicans echoed the angry anti-government themes during floor debate on the legislation..

"If I was a moderate Republican, I'd be awfully concerned after seeing Congressman Boehner channeling the howling rage of the Tea Party crowd outside the Capitol,'' said Jim Manley, spokesman for Senate Majority Leader Harry Reid (D-Nev.).

Another point of controversy arose from House debate in the wake of the decision by Rep. Bart Stupak of Michigan, whose Sunday afternoon deal with the White House over blocking federal funds for abortion helped clinch the narrow margin of victory.

Sunday evening, as Stupak spoke on the floor, a then-unidentified GOP member yelled "baby killer." Monday, Rep. Randy Neugebauer of Texas came forward and said he had yelled the epithet, but that he was referring to the reconciliation bill, not to Stupak himself.

Rep. James Clyburn, the House Democratic Whip, said Monday the lawmaker should apologize before the entire house. The episode was reminiscent of when Rep. Joe Wilson (R-S.C.) shouted "You lie!" during President Obama's address to Congress last year.

In a statement, Neugebauer said, "The House chamber is a place of decorum and respect. The timing and tone of my comment last night was inappropriate."

Stupak's office said Monday his phones were jammed. Indeed a recorded message spoke of "heavy call volume" as if the numbers was a customer service line. While many callers were angry, a spokesperson said, others were grateful for the congressman's role in breaking the impasse.

But anti-abortion advocates were not in a forgiving mood. "Everybody knew he was under a lot of pressure and we were sympathetic to that," Charmaine Yoest, president of Americans United for Life Action said. "But the way it all played out it ended up feeling like a real craven betrayal."


---After the votes, a battle to frame health-care bill for the midterms
By Dan Balz | March 22, 2010; 2:40 PM ET
http://voices.washingtonpost.com/44/2010/03/after-the-votes-a-battle-to-fr.html

The polarized debate over health care moved into a new phase Monday, as Democrats and Republicans shifted their focus to the November elections and what could turn into a referendum on the most significant social legislation enacted in half a century.

"The real political battle over health-care reform begins after its passage," said Democratic strategist Chris Kofinis. "We can't let Republicans seize the message advantage here, as they did during last summer's "tea party" and town hall protests. For Democrats, it means we must take the initiative and aggressively sell this reform to the American people not for a few days, or weeks, but all the way through the election."

That will start Tuesday with a White House signing ceremony, even as the Senate takes up legislative changes designed to satisfy House complaints about the bill that was approved on Sunday. As Republicans prepare to campaign on a pledge to try to repeal the health-care measure, Obama and the Democrats will try to keep voters focused on the benefits of the changes, not the size, cost or complexity of the bill.

Health care will not be the only issue in the fall. The economy may loom larger by November than the heated debate that has raged for more than a year over Obama's health initiative. But health care will also become a proxy, say strategists in both parties, for the continuing debate over whether Obama's presidency represents a return to bigger and more intrusive government.

One measure of that came in a statement from Gov. Mitch Daniels (R-Ind.). Saying the measure will raise taxes and, contrary to projections, will add to the national debt, he said, "In a life of optimism about America and its future, this morning I am as discouraged as I can remember being."

Both parties confront new tests in the wake of Congress's action. Democrats must motivate and persuade voters who, for varying reasons, have been turned off by the long debate on Capitol Hill and by the president's policies. Republicans must show that their dire predictions about the impact of the health-care changes were real and not just the politics of fear and opposition.

Obama and party leaders face two challenges as they begin to sell the new health-care system. First, they must motivate a Democratic base that for months has been demoralized, lethargic and divided over whether the heath-care legislation lived up to their expectations for change.

Second, they need to win back many of the independent voters who backed them in 2006 and 2008 but who shifted sharply to the GOP in the off-year gubernatorial elections in Virginia and New Jersey and the special Senate election in Massachusetts two months ago.

Pollster Peter Hart argued that the most important priority will be invigorating the Democratic base, in large part because midterm elections are often dominated by activists on one side or the other and for months Republicans have been far more energized than Democrats.

"Unless they get Democrats interested in this election, they're going to get smoked," he said. "The most important things for them is to develop interest. I think a 'yes' vote and a Democratic victory helps to change that dynamic."

Hart cited results from a recent NBC News-Wall Street Journal poll showing that, among the most motivated voters, Republicans held a double-digit lead on the question of which party those voters plan to support in House elections next fall.

The president sought to link passage of the measure to his 2008 campaign when he spoke minutes after the House voted on Sunday night. "This is what change looks like," he said. That is a message designed to reassure voters who may have become disillusioned with his leadership, but he and other Democrats have more to do to win the public relations battle ahead.

Democratic officials believe that passage of health care will give Obama a boost in the eyes of the public. "Part of the test here at the end wasn't this policy or that policy," White House Chief of Staff Rahm Emanuel said. "It was, 'did he have the capacity to deliver?' That question mark around him and the presidency has been answered."

Based on historical evidence, any rise in Obama's approval ratings will have a direct effect on his party's success in the fall.

Republicans lost the battle over health care in Congress, but still believe they hold the high ground politically, especially in districts likely to be competitive this fall.

Public Opinion Strategies, a Republican polling firm, conducted a poll of people in the districts of 36 Democrats who voted against health care last November. In 2008, Republican John McCain carried 29 of those districts over Obama.

The findings showed 60 percent in those districts opposed to the health care bill and only 35 percent in favor. In addition, the survey showed that nearly half said they were strongly opposed.

A handful of the Democrats who had opposed the bill in November voted for it Sunday night. "I sure wouldn't want to be a Democrat who switches his vote from no to yes in one of these districts that McCain carried," said POS's Bill McInturff. "The intensity against the bill in these districts is stunning."

White House senior adviser David Axelrod said that, for all Democrats, passage lifts a potential burden. "If the bill had failed, every one of these candidate who voted for it would have been stuck with a caricature of the bill that would have been potentially politically debilitating," he said. "All these sky-is-falling predictions won't materialize."

Most of those Democrats opposed the health-care measure throughout the congressional debate, giving them some protection against the expected Republican assault on the measure. But they will be running into headwinds in their districts, unless Obama and his Democratic allies can move public opinion in the next few months.

In the morning-after analyses, at least one prominent Republican commentator questioned his party's strategy of outright opposition to the health-care bill. David Frum, who was a speechwriter for former President George W. Bush, said the health care debate amounts to the party's "most crushing defeat" in four decades.

Frum went on to argue that Republicans may be overly optimistic about their chances of major gains in November and said the GOP has only itself to blame for what has happened.

That is a distinctly minority view, however. "I don't think Republicans have miscalculated," said Carl Forti, a GOP strategist. " They played this extremely well and opposed the bill with success....While every bill may have a few positive things in it, overall this bill is a bad bill, and for the Democrats in GOP-leaning seats, it's going to be a vote that's hung around their neck like Hester Pryne and her scarlet A."

But, said Axelrod: "I think the debate shifts now. The issue for those talking about repeal is whether they're going to look the small business people in the eye or the children and say this was a horrible. I'm happy to have that debate."


---Obama's Historic Health Care Bill Also A Political Gamble---
Jim Malone | Washington 22 March 2010
http://www1.voanews.com/english/news/usa/Obamas-Historic-Health-Care-Bill-Also-A-Political-Gamble-88868692.html

President Barack Obama won a major political victory this week with congressional passage of his health care reform plan. Mr. Obama and congressional Democrats made history with the reform legislation, but politically the bill is a major gamble and opposition Republicans have vowed to exact revenge in congressional midterm elections this November.

Unlike many of his predecessors, President Obama scored a political success on health care. But it remains to be seen whether it is a political blessing or a curse.

Many political experts do see passage of the health care reform bill as historic, including Ross Baker of Rutgers University in New Jersey.

"This is something, after all, that first came to the attention of the American public 100 years ago when a national health insurance program was proposed by President Theodore Roosevelt, and successive presidents, mostly Democrats but not all, have favored it," said Ross Baker.

The Obama plan approved by Congress will eventually extend health insurance coverage to 32 million Americans who were previously uninsured. The plan will cost nearly $1 trillion over 10 years and will be paid for through a combination of tax increases and projected savings in health care spending. The bill will also curtail the ability of health insurance companies to limit or end coverage.

Mr. Obama was elected president in 2008 on a promise of change and quickly made health care his top domestic priority. After a battle in Congress that lasted more than one year, the president and his Democratic allies in Congress finally prevailed.

"We did not avoid our responsibility, we embraced it," said President Obama. "We did not fear our future, we shaped it."

Political analyst and author Richard Wolffe says there is little doubt that the scope of the Obama health care plan makes it historic.

"The underlying legislation is far-reaching and is sweeping," said Richard Wolffe. "It may not be everything everyone hoped for, but it does have an impact on this huge and growing part of the American economy, as well as being part of the Democratic [Party] dream for so many generations."

Even though the health care bill is historic, it is also a huge political gamble. Public opinion polls show more Americans oppose the Obama plan than support it, and the president was unable to win a single Republican vote in Congress.

Republicans like Indiana Congressman Mike Pence believe that the president and his Democratic allies in Congress simply defied the will of the American people and will now pay a steep price in the congressional midterm elections in November.

"This is not the president's House," said Mike Pence. "This is not the Democrat's House. This is the people's House, and the American people don't want a government takeover of health care!"

The health care debate also fueled the rise of the so-called Tea Party movement, loosely organized groups of grass roots conservative, Libertarian and anti-tax activists who opposed the health care plan as too much government involvement in the economy.

Conservatives may have lost the battle in Congress, but they have vowed to defeat Democrats who supported the bill in the November elections.

Tom DeFrank is a veteran political observer with the New York Daily News and a regular guest on VOA's Issues in the News program.

"I think the Republicans are doing what they are doing because they believe it works to their political advantage, and it is certainly clear for about the last six to nine months that it has worked," said Tom DeFrank.

The divisive health care debate has left a bitter aftertaste with lawmakers from both parties, and experts including Richard Wolffe see little hope for the kind of bipartisanship that President Obama talked about when he first came into office.

"Yes, another part of his ambition was to change the tone and the politics and the way politics is done in this town, and that has been a singular failure," he said. "They were not expecting the kind of permanent campaign that Republicans ran, which was, frankly, a little bit naive, and that has frustrated his efforts to be a bipartisan leader, which was really his goal."

Most experts believe that the partisan nature of the health care debate makes it less likely that Congress will make progress this year on other important issues like immigration reform and climate change.

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