It is hailed as a historic victory, but what does the bill really amount to?
By David Cairns

After years of intense debate in the legislature, across the nation
and throughout the media, Barack Obama's healthcare reforms, which
have divided the US as nothing has since the Vietnam war, are to
become law.

A vote last night in the House of Representatives will take the
country closer than it has ever been to universal healthcare and
spells historic victory for the President and his Democrats - while
Republicans believe it will lead to their opponents' downfall at the
polls.

"This is what change looks like," said Obama late last night at the
White House, Vice President Joe Biden at his side. "Tonight, at a time
when the pundits said it was no longer possible, we rose above the
weight of our politics.

"This legislation will not fix everything that ails our healthcare
system, but it moves us decisively in the right direction," he added.

In a few hours' time, the President is expected to sign the bill into
law. The bill was passed by 219 votes to 212, with every Republican
voting against it – and 34 Democrats, some of whom feared it as a
vote-loser. When the ballot hit the 216 needed to ensure their
victory, Democrats hugged each other, cheered and chanted Obama's
campaign slogan: "Yes we can!"

What will the bill do?The Patient Protection and Affordable Care Act,
which will cost $940bn over 10 years, will bring healthcare to 32m
more of the USA's poorest people, taking coverage across the country
to 95 per cent.

Its main provisions are to make health insurance almost mandatory,
targeting individuals and employers; to vastly increase the threshold
that determines who is eligible for financial healthcare support from
the state; to reduce the price of drugs available to them and to
prevent insurers from refusing to cover people with pre-existing
medical conditions.

How are the American public reacting?As the bill came closer to law
over the weekend, thousands of protesters gathered in Washington DC to
heckle congressmen. Some hurled racist and otherwise derogatory
remarks at African-American members including one of the 1960s civil
rights veterans, John Lewis. A congressman was spat on, and another
was calleda "faggot".

It is no exaggeration to say the reforms have split America. While the
anti-Obama 'Tea Party movement' (some say it is less a movement and
more a Republican-orchestrated campaign) might still have come into
being with or without the reforms, they have provided a focus for it -
and for all Obama's opponents. The Republicans believe their staunch
opposition to reform will hand them power at this year's mid-term
elections, though Democrats argue that once the bill is law it would
be political suicide for anybody to attempt to withdraw it. And the
bill will certainly silence critics of Obama as a 'do nothing
President'.

Is the bill now certain to become law?Yes, it is - but a second bill,
containing amendments to the first, still has to be passed. It's
thought it easily will be, because of a deal between Democrats in the
US's two legislatures – the lower 'House of Representatives' (or
'House') and the upper 'Senate'. But Republican voices have already
been raised in complaint that this deal is "unconstitutional".

Last night's vote in the House was on a version of the healthcare
reform bill already passed by the senators, who have made changes that
Democrats in the House don't like. They agreed not to argue about
those changes when Senate leader (and Democrat) Harry Reid promised
that if they instead submitted a second bill with their amendments,
his senators would pass that unopposed. This second "reconciliation"
bill will go before the Senate later this week and could be wrangled
over for weeks – but will almost certainly become law.

What about truck-driving reform-killer Scott Brown?Many observers
thought Obama's healthcare reforms bill had been scuppered by the
shock election victory in January of Republican former male model and
self-proclaimed truck driver Scott Brown. Brown took the veteran
uber-Democrat Ted Kennedy's seat in the Senate on the latter's death,
busting the Democrats' majority of 60 out of 100 seats. To pass
without incident, a Senate bill needs a 60 to 40 majority, not 51 to
49, so this looked disastrous for Obama.

Obama's great escape was via the reconciliation bill deal. By couching
their amendments to the healthcare bill in a separate,
'reconciliation' bill, the Democrats found a procedural loophole: this
type of bill only needs a simple (51 to 49) majority to pass, and
their 59 Senators should manage that without upset.

Has the bill been watered down?As the BBC's North America editor, Mark
Mardell, writes in his blog today: "Many liberals feel there have been
so many compromises the bill is hardly worth it." Some wanted to go
much further, instituting an NHS-style system. But Obama's supporters
say he has achieved reforms which eluded Presidents including Teddy
Roosevelt, Richard Nixon and Bill Clinton.

In January, the Democrats almost withdrew the bill in its current
form. After the news came in that they had lost their 60-seat Senate
majority, some in the party wanted to amend the bill to a safer
version more likely to be passed. But, after some internal wrangling,
the idea was rejected and they pushed ahead with the bill as it stood.

The bill's final victory was only assured after Obama cut a deal with
anti-abortionist representatives, including a proviso that prevents
federal money being spent to "encourage" abortion. An exception was
made for forced or incestuous pregnancies.

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