Washington (CNN) -- President Obama signed sweeping health care reform legislation into law Tuesday, hailing the moment as the latest example of America facing up to major challenges for the benefit of all its people.
The bill constitutes the biggest expansion of federal health care guarantees in more than four decades, and its enactment was a giant victory for Obama and Democrats after a brutal legislative battle dating back to the start of his presidency.
No Republicans supported the bill in either the House or Senate, and Democratic leaders needed a separate bill that calls for changes in the new law in order to get enough support in the House to pass the measure.
The Senate started debate on the accompanying House bill later Tuesday, with Republican opponents promising to use every possible parliamentary tool or technique to undermine it.
Obama and Democratic leaders celebrated the new law at the White House signing ceremony, with a crowd packing the East Room repeatedly standing to applaud and cheer the president.
"It's been easy at times to doubt our ability to do such a big thing, such a complicated thing, to wonder if there are limits to what we as a people can still achieve," Obama said.
"We are not a nation that scales back its aspirations," he continued. "We are not a nation that falls prey to doubt or mistrust. We don't fall prey to fear."
Rather, "we are a nation that does what is hard, what is necessary, what is right," Obama said. In the end, he said, the bill delivered the "core principle that everybody should have some basic security when it comes to their health care."
Among those on hand for the signing ceremony was Vicki Kennedy, the widow of Sen. Edward Kennedy of Massachusetts, who championed health care reform for decades before his death last year.
Also present were several people who wrote Obama in the past year about their personal woes over losing or being unable to get health insurance. Obama had told their stories when campaigning for the health care bill in recent months.
Among the private citizens attending Tuesday's ceremony were 11-year-old Marcelas Owens of Washington state and Ryan Smith, a small-business owner from California.
And Obama said, "I'm signing this reform bill into law on behalf of my mother, who argued with insurance companies even as she battled cancer in her final days."
Democratic senators and representatives filled the crowd, and all stood to cheer and applaud after Obama used 22 pens to sign the bill.
Republicans and social conservatives are vowing to try to repeal the law or have it declared unconstitutional. Attorneys general from 13 states filed a lawsuit Tuesday against the measure, claiming its mandate for people to purchase coverage and the costs it forces states to assume violate the Constitution.
Twelve of the 13 attorneys general filing the lawsuit are Republican. A separate lawsuit filed by the Republican attorney general of Virginia makes a similar claim.
Obama's comments at the signing ceremony and a later appearance before staff and supporters at the Department of the Interior focused on the immediate benefits of the new health care law.
The president emphasized that this year, some 4 million small-business owners will be able to get tax credits to help cover the cost of providing health insurance to their employees, while insurance companies will no longer be able to deny coverage for children because of pre-existing medical conditions.
Insurance companies also will no longer be allowed to drop people from coverage when they get sick, or to place lifetime or annual limits on the amount of health care people receive, Obama said.
In addition, he warned senior citizens to ignore claims by Republicans that the new law will reduce Medicare benefits.
Obama will hit the road to sell the measure to a still-skeptical public, giving a speech Thursday in Iowa City, Iowa, where he launched his grass-roots drive for health care reform in May 2007, according to White House press secretary Robert Gibbs.
Passage of the bill was a huge boost for Obama, who made health care reform a top domestic priority of his presidency.
"I haven't seen the president so happy about anything other than his family since I've known him," senior adviser David Axelrod told CNN on Monday, adding that Obama's jubilation when the bill passed exceeded his election victory in November 2008. "He was excited that night, but not like last night."
Senior Republicans in Congress warned that voters will judge Democrats harshly in November's mid-term elections, with Sen. John McCain of Arizona saying the Democratic-passed bill killed any chance of bipartisan support on legislation for the rest of the year.
"There will be no cooperation for the rest of this year," McCain said in an interview Monday with KFYI radio in Arizona. "They have poisoned the well in what they have done and how they have done it."
Gibbs, however, said the administration expects to win any lawsuits filed against the bill, and he challenged McCain and other Republicans to campaign for the November election against the benefits of the health care bill.
The overall $940 billion plan is projected to extend insurance coverage to roughly 32 million additional Americans.
The compromise package would expand insurance subsidies for middle- and lower-income families, and scale back the bill's taxes on expensive insurance plans.
Observers warn, however, that the road ahead for health care reform in the Senate may be rocky. Democratic leaders are using a legislative maneuver called reconciliation, which will allow the compromise plan to clear the Senate with a simple majority of 51 votes. But according to Senate rules, members are still allowed to offer unlimited amendments and challenges.
In one of the first of many attempts Republicans say they will make to try to amend or kill the package, GOP aides went to Senate Parliamentarian Alan Frumin on Monday to argue that the compromise bill violates rules of the reconciliation process because of the way it affects Social Security. For that reason, GOP aides said they argued, the bill should not even be allowed to be debated.
However, Frumin, according to a senior Republican and a Democratic aide, informed both parties he disagreed with the GOP assessment, and would not block the bill from reaching the Senate floor.
House Democrats unhappy with the Senate bill have been continually reassured that the compromise package will be approved by the more conservative Senate.
So far, two of the 59 senators in the Democratic caucus -- Ben Nelson of Nebraska and Blanche Lincoln of Arkansas -- have said they will oppose the compromise package.
Health Care Reform: Tax Hikes on the Way - Kiplinger
Health Care Reform:
Tax Hikes on the Way
Here are 13 changes in the massive overhaul that could impact your tax bill, for better or worse.
By Joan Pryde, Senior Tax Editor, the Kiplinger letters
March 23, 2010
The new health care reform law is chock-full of new taxes and tax increases that will affect many individuals and businesses, but it will be years before most of these hikes take a bite out of your -- or your company’s -- wallet. The law also has tax breaks to help both individuals and small businesses pay for insurance.
Figuring out exactly what the new law’s impact will be on your finances will be tricky, not only because many of the effective dates are delayed, but also because the law signed by President Obama will most likely change very soon: After passing the Senate bill on March 21, the House also approved a package of modifications that the Senate plans to pass before the end of the month.
Some Health Care Changes to Happen Quickly
Companies That Will Gain from Health Care Reform
Health Care Reform: What Firms Will Do
More Tax Breaks for Business Coming Soon
Take a look at what’s coming down the road, starting with provisions that take effect first:
•A new 10% excise tax on indoor tanning services that takes effect for services provided after June 30, 2010.
•Giving small firms tax credits as incentives to provide coverage, starting this year. Employers with 10 or fewer workers and average annual wages of less than $25,000 can receive a credit of up to 35% of their health premium costs each year through 2013. The credit is phased out for firms larger than that and disappears completely if a company has more than 25 employees or average annual wages of $50,000 or more. Beginning in 2014, small firms that sign up with one of the health exchanges to be created can receive a credit of up to 50% of their costs.
•A requirement that businesses include the value of the health care benefits they provide to employees on W-2s, beginning with W-2s for 2011.
•Elimination, after this year, of a deduction employers now take for providing Medicare Part D prescription drug coverage to their retirees to the extent that the federal government subsidizes the coverage. This will not take effect until 2013.
•Doubling the penalty for nonqualified distributions from health savings accounts, to 20%, beginning in 2011.
•A limit on the amount that employees can contribute to health care flexible spending accounts to $2,500 a year. Under the House package of changes, the cap won’t take effect until 2013.
•A ban on using funds from flexible spending accounts, health reimbursement arrangements or health savings accounts for the cost of over-the-counter medications, starting in 2011.
•Imposing a 0.9% Medicare surtax on wages of single taxpayers earning more than $200,000 a year and couples earning over $250,000, starting in 2013. In addition, the House’s package of modifications would levy a special 3.8% Medicare tax on the unearned income of those taxpayers. The House defines unearned income as interest, dividends, capital gains, annuities, royalties and rents. Tax-exempt interest would not be included, nor would income from retirement accounts.
•A hike in the 7.5% floor on itemized deductions for medical expenses to 10%, beginning in 2013. But taxpayers age 65 and over are exempt from the cutback through 2016.
•A new 40% excise tax, beginning in 2013, on high-cost health plans, defined as those providing coverage in excess of $8,500 for individuals and $23,000 for families. The House’s package of modifications includes higher threshold amounts and an initial effective date of 2018.
•A new tax on individuals who don’t obtain adequate health coverage by 2014. The tax is be phased in over three years, starting at the greater of $95, or 0.5% of income, in 2014, and rising to the greater of $750, or 2% of income, in 2016. The House passed companion measure would modify this provision so that a person without coverage in 2014 would pay the greater of $95, or 1% of income, and in 2016 would pay the greater of $695, or 2.5% of income.
•Providing a refundable tax credit, once the individual mandate takes effect in 2014, to help low-income folks purchase coverage. To be eligible, a person’s household income must be between 100% and 400% of the federal poverty level, generally around $11,000 to $44,000 for singles and $22,000 to $88,000 for families.
•A nondeductible fee charged to businesses with 50 or more employees if the firms fail to offer adequate coverage. The fee will equal $750 times the number of workers in the firm, and is slated to go into effect in 2014. The House’s package of modifications would increase that fee to $2,000 times the number of employees, though it would not count the first 30 workers in that calculation.
Last edited by Sith Lord; 03-24-10 at 12:16 PM.
San Francisco: Decoding the "healthy surcharge" - This Just In - Budget Travel
San Francisco: Decoding the "healthy surcharge"
Posted by: Justine Sharrock, Tuesday, Feb 16, 2010, 11:12 AM
If you've been to my fair city recently, you might have noticed that some restaurants have an extra line on the end of the check that reads "Healthy San Francisco Surcharge." This fee allows restaurateurs to help pay for the city's health care program. The small charges vary: Some are a percentage of the total (usually around 4 percent), others tack on a dollar or two.
Not all restaurants include the charge, but by city mandate, all businesses with 20-plus employees have to either offer health insurance or help pay for the city's health care access program, Healthy San Francisco. HSF isn't insurance, per se, but it does offer affordable health care for uninsured residents of the city who don't qualify for Medicare or Medi-Cal.
The city charges businesses $1.31 to $1.96 an hour for each employee who needs HSF, depending on company size. Restaurants, just like other employers, are looking for a way to offset that cost, either by adding a surcharge or by simply increasing menu prices.
HSF is wildly successful and popular (94 percent of users surveyed by the Kaiser Family Foundation expressed satisfaction), but the added restaurant surcharges are controversial.
Most restaurant owners want to offer health care, but they argue that having private businesses (instead of the government) pay for the city's health care program is an unfair financial burden.
Starting in 2008, restaurants like Zuni Cafe, Max's Opera Cafe, and Rose Pistola started adding a "Healthy San Francisco" fee to alert customers to the cost of the program, instead of just raising prices. A group of restaurateurs have even filed a suit against the city arguing the employer mandate violates the Employee Retirement Income Security Act. The U.S. Supreme Court has delayed any action, instead seeking advice of President Obama; he has yet to respond.
Some locals are frustrated. "I'm losing my patience with the way restaurants are handling the 'Healthy San Francisco initiative,'" San Francisco Chronicle food critic Michael Bauer has written on his blog. He argues that restaurants should simply raise the menu prices to cover the HSF costs.
So, how does this affect you? Well, you have to pay the surcharge. But you don't have to include the charge when figuring tip. Many locals see it as an annoyance; but on the flip side, unlike many places in the U.S., San Francisco's waitstaff has access to affordable health care.
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