Health care: Winners and losers

The Democrats' health-care overhaul is about to become law. Whom does the controversial package help—and whom does it hurt?

Health care reform
(Image credit: Corbis)

The House passed health-care reform legislation Sunday night, sending the historic but controversial measure to President Obama's desk. The 219–212 vote follows a year of heated debate, and promises to have far-reaching consequences. (Watch The Week's Sunday Talk Show Briefing on the health care bill's impact.) Here's a look at some probable winners and losers from the bill's passage:


Barack Obama: Not only did passing health-care reform potentially save his presidency, says Matthew Yglesias in Think Progress, but Obama's progressive reshaping of policy also puts him "down in history as one of America's finest presidents." Like Ronald Reagan, this political "resurrection" of Obama shows that he can "come back and fight," says Andrew Sullivan in The Times of London, which people admire even if they don't agree with what he's fighting for. Passing health care does make Obama "one of the most consequential presidents in history," says Mark Steyn in National Review, but America will pay a high price for his victory, and so will he.

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Nancy Pelosi: The House speaker's skillful rounding up of votes shows she's "the best Democratic parliamentary manager since Sam Rayburn," says Richard Adams in The Guardian. "Pelosi should probably be Time's Person of the Year for getting this done," agrees Nate Silver at FiveThirtyEight. It's all well and good to "admire Nancy Pelosi's skill as a legislator" now, says Megan McArdle in The Atlantic, but she won't look so brilliant when the GOP retakes the House and similarly pushes through bills voters don't like: "Farewell, Social Security! Au revoir, Medicare!"

Bart Stupak: The pro-life Democrat was the "vital" vote for health care-reform, says The Guardian's Richard Adams, with the last-minute executive order he forced out of Obama paving the way for a bloc of holdouts to vote "yes." By the time the final votes were cast, says Andrea Seabrook at NPR, "Stupak had gone from a virtual pariah among House Democrats to their health-care hero." If he's a hero, he's of the Hollywood variety, says Michael van der Galien in PoliGazette. His opposition to the bill was always a "sham"—as is the whole idea of a pro-life Democrat.

The uninsured: The law will add an estimated 32 million to the ranks of the insured. The big change in the bill is that it moves America from a system in which "people can assume they will have health coverage IF they are old enough (Medicare), poor enough (Medicaid), fortunate enough," or in some other special category, says James Fallows in The Atlantic, toward one where they can assume they'll have coverage, "period."

Drug companies: Brand-name drugmakers "signed on early to work with [the bill] instead of blocking it," says the New York Daily News. And in return, they get millions of new insured people able to buy their medicines.


Republicans: There's "little dispute" that losing the health-care reform vote means the GOP has "suffered one of its biggest setback in years," says Charles Cooper at CBS News. And it was completely avoidable, says Jonathan Chait in The New Republic. Democrats were "desperately hoping for bipartisan cover," and the GOP could have killed reform by negotiating a little in good faith, thus fatally splitting Democrats. Democrats should enjoy "their self-congratulatory night and day or two," says Dan Riehl in Riehl World View, because Republicans now have something to unite behind and fight for, and "we will win in the end."

Congressional Democrats: Obama convinced enough Democrats to join him, says John Dickerson in Slate, but he "was really asking some of them to lose their jobs" by voting for the unpopular bill. We won't know how many Democrats "lost their jobs last night" until November, says B. Daniel Blatt at Gay Patriot, but it's not a small number. Passing health care has "destroyed" the Democrats, says Newt Gingrich, quoted in The Washington Post, in much the same way LBJ's civil-rights laws "shattered" the party for 40 years.

Tea Party Movement: Tea Partiers had a bad PR weekend, with protesters reportedly spitting on a black Democratic congressman and shouting racist and anti-gay epithets at others. So the passage of health-care reform was also an important defeat for the "vicious, unprincipled fear offensive" of Tea Party activists, says Paul Krugman in The New York Times. Well, that's clearly what the "media message" is going to be, says Glenn Reynolds at Instapundit. But in reality health care "would have been passed nearly a year ago" without the Tea Party—and wouldn't have come at such a "brutal political cost" to Democrats.

The wealthy: A key funding mechanism for the bill is a bump in payroll and investment income taxes for people who earn more than $200,000 a year. Citing "tax experts at Deloitte," Forbes says, the changes would amount to a $287,100 tax hike for a couple with annual income of $5 million.

Illegal immigrants: The new law will cover an estimated 32 million Americans, but not the 12 million to 20 million immigrants working in the U.S. without permission. Democrats dropped a provision that would include them in the face of Republican opposition.

Tanning salons: Indoor tanning services will see a new 10 percent tax, potentially hitting the pocketbooks of the unseasonably bronzed. The tax seeks to raise $2.7 billion in revenue over 10 years, and also discourage the use of a product tied to increased skin cancer.



• Health care reform: By the numbers

• Is Obama now a "great" president?

• Health care reform: What's next?

• The Tea Party's Capital Hill protests: "Disturbingly racist"?

• Abortion: Who compromised the most?

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