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House passes historic and controversial health care bill -- Collin Peterson votes no

The U.S. House voted 219 to 212 to pass its historic and wildly contentious vote on health care reform Sunday.

Widely regarded as a major victory for President Obama and House Speaker Nancy Pelosi, the bill passed without a single Republican vote.

It also passed without the vote of U.S. Rep. Collin Peterson, who represents western Minnesota, including Becker County.

Peterson explained his vote in a statement:

After thorough and careful reading and review of the health care legislation the House considered this evening I was not convinced that it was right for the people of Minnesota's 7th District and so I voted against it. Some people will appreciate that and some will be disappointed, but I made this decision because I thought it was the right thing to do for the people I serve, and that's everyone who lives in the 7th District.

Most people recognize that our health care system needs reform and since this reform effort began I have talked with a great many 7th District Minnesotans about what was needed. The clear consensus was that we needed to reduce the cost of health care -- for individuals, families, employers and the government - to expand coverage, and to fix the problems we have without destroying the parts of the system that are working.

If the bills we voted on tonight had measured up to these standards I would have supported them, but they did not. In my judgment, while these bills deliver some good things they miss the mark on the most important things and will not deliver as promised.

This legislation doesn't control costs, doesn't reform Medicare, and only covers 37% of the uninsured in the 7th District as opposed to an average of 68% nationwide. Some districts will see coverage expanded to cover as much as 92% of the uninsured and Minnesotans will paying for that while leaving 63% of our 7th District residents without coverage.

This is very similar to the way the Medicare geographic disparities problem was created back in 1982. The geographic payment disparity encourages cost-shifting and rewards low quality / high cost health care providers in other states while forcing Minnesota to do more with less. Instead of fixing that problem - which we need to do -- this legislation will lock us into that same disparity situation with regard to the uninsured.

Minnesotans will be asked to do more with less while also covering costs in other states that aren't doing the right thing for their own citizens. And on top of that this legislation will not control costs - in fact it seems to me that it will do just the opposite; health insurance premiums will rise. CBO has said that premiums for individuals will increase 10-13%.

That said, there are some good things in this legislation. It will end pre-existing condition exclusions for children within six months of enactment and do the same thing for adults when the "exchange" marketplaces are operative in 2014 - if they work as proponents claim they will, which is doubtful.

It will allow children to stay on their parents' health care plans until age 26, and it will end the practice of rescinding coverage when you get sick.

However, this legislation avoided making the critical reforms we really need in order to strengthen our rural health care system and by doing so it punts these problems into the future where it's likely that they'll be even more difficult and more expensive to solve.

As the Administration begins putting these reforms in place I will continue working to fix the problems I've mentioned and to ensure that everyone in the 7th District has access to affordable health care. I will work to hold the Administration accountable and I will keep working to make the changes we need in order for these new policies and health care delivery systems to be workable in rural areas.

Throughout my service in Congress I've made it a point to study each issue and each piece of legislation and cast my votes according to what makes the most sense for the people of the 7th District. That is what I've done again this evening.

Rep. Earl Pomeroy, D-N.D., announced that he would vote for the legislation because it "will literally be a lifesaver for North Dakotans."

Joined in a teleconference by the state's two U.S. senators, Democrats Kent Conrad and Byron Dorgan, Pomeroy said the bill would strengthen consumer protections and Medicare benefits for senior citizens, ensure that North Dakota hospitals are treated fairly under Medicare reimbursement payments, cut the cost of health care for middle-class families and small businesses, and significantly reduce the federal deficit.

Pomeroy said the bill would "protect consumers from abusive practices that have been a perennial part of the insurance marketplace" and make health insurance more affordable than any other proposal he's seen.

"It is not a government takeover of health care," Dorgan said and the others repeated, addressing one of the most persistent challenges offered by opponents of the bill, who in recent days had flooded congressional offices with protest calls and staged raucous demonstrations at the Capitol.

The three lawmakers acknowledged that the bill "isn't perfect," in Pomeroy's words, but they emphasized that the legislation has strong support from doctors, nurses, hospitals and other health care providers.

Republicans were quick to respond.

"To say this is a flawed bill is an understatement of epic proportions," Tom Erickson, spokesman for the National Republican Congressional Committee, said in an email Sunday.

"Hidden within its pages are massive cuts to Medicare, hundreds of billions of dollars in tax increases and infamous backroom deals.

"By supporting a massive government takeover of health care that will cause insurance premiums to rise, Earl Pomeroy has all but guaranteed that his current term in Congress will be his last."

Pomeroy said he is "disappointed over the sharply partisan divide over its passage," but "if we walk away now, Congress will not return to it for many, many years," leading to higher premiums, higher costs, more uninsured and more red ink in the federal budget.

Pomeroy is seeking a 10th term this fall and will face Republican Rick Berg of Fargo, nominated by his party Saturday and already signaling that the health care reform issue will be a key part of his campaign.

"Obviously I'm disappointed that he's voting against what a majority of North Dakotans want," Berg said Sunday following Pomeroy's announcement.

"This health care bill is a job killer at a time when we have almost 10 percent unemployment in this country, and our No. 1 priority should be getting people back to work and encouraging small business to grow. This bill really will have the opposite effect."

Berg also said he has heard from many people who "feel they should have a choice on health insurance" and are concerned about the legislation's effect on taxes.

Asked about the politics of Sunday's vote, Pomeroy said, "The months to come will sort this out," and that he would press the message that "this is going to make things better for North Dakotans."

The delegation members said the reform package contains nothing authorizing any direct or indirect federal funding for abortion, with Pomeroy noting that Catholic nuns came to his office this week to express support for the bill and affirm that it is "for life."

He said he had "been working very closely with Rep. Bart Stupak," a Michigan Democrat and leading abortion opponent in Congress, "to make absolutely certain that this bill does not directly or indirectly" provide federal subsidies for abortion.

Pomeroy said he welcomed President Barack Obama's stated intention to provide "further clarification" on the abortion issue in an executive order.

The delegation members said they are supporting the reform legislation because it would bar insurance companies from denying or dropping coverage based on pre-existing conditions, health status and gender. They said that would help 8,200 North Dakotans with pre-existing conditions get coverage, citing numbers from the House Energy and Commerce Committee.

The bill "corrects a decades-old injustice that shortchanges North Dakota hospitals and doctors on Medicare reimbursements," they said, bringing about $650 million in revenue into the state over the next decade. That would allow the state's hospitals and clinics to hire more staff and expand and improve care. The North Dakota Hospital Association has called the bill "a historic step forward for health care in North Dakota."

The lawmakers said the bill eliminates the Medicare "doughnut hole" -- the gap in prescription drug coverage that puts the cost on seniors and discourages them from continuing to take the medication they need, according to the delegation. It also provides new services and eliminates out-of-pocket copayments for preventive benefits for the 106,000 North Dakotans who depend on Medicare.

"The most important issue for North Dakota is this legislation will finally correct a longstanding injustice," Dorgan said, "not just for our state but for others where Medicare (reimbursement) payments are far below what they should be."

He said that administrators of major North Dakota hospitals "have told me they'd have to start laying off people and reducing services" if the bill with the Medicare reimbursement changes failed.

Dorgan announced earlier this year that he would not seek another term in the Senate. Republicans nominated Gov. John Hoeven Saturday to seek the seat. Democrats will nominate a candidate at their state convention in Fargo this weekend.

In a prepared statement distributed by email prior to the half-hour teleconference, Pomeroy and the senators said the bill would provide an immediate 35 percent tax credit to small businesses offering health coverage to employees. When the new insurance exchange is set up, employers who purchase coverage receive a two-year tax credit of up to 50 percent of the their costs to offer insurance.

In addition, they said, the bill provides middle class families (incomes up to $88,000 for a family of four) with tax credits to help pay for coverage in the exchange. For a family of four making $50,000, the average tax credit will be approximately $5,800, they said, citing numbers from the House Ways and Means Committee.

Conrad said one of the most important factors in his decision to support the legislation is the Congressional Budget Office assessment that it will reduce the deficit by $143 billion in the first ten years after it is enacted and by $1.2 trillion in the second ten years.

Speaking to opponents' complaints about procedures employed by Congressional Democrats to advance the controversial legislation, Conrad noted that the bill was passed without use of "reconciliation" in the Senate in December and that the House would vote "straight up and down" on the Senate bill.

The House then would vote on a package of "improvements" to the Senate bill using reconciliation, he said, and then send that on to the Senate.

Bill was passed without reconciliation. House will vote straight up and down.

"That is entirely in keeping with how reconciliation has been used in the past," he said, including 16 times when Republicans were in charge

Conrad and Dorgan said that "many amendments" are likely when the reform package returns to the Senate, but they declined to say how they might vote on "hypotheticals."