WASHINGTON (Reuters) - The U.S. Congress approved a package of final changes to President Barack Obama’s landmark healthcare overhaul on Thursday, and Obama dared Republicans to try to repeal the new law.
The House of Representatives put the finishing touches on the overhaul by passing a companion package that would make insurance more affordable, raise taxes on the wealthy and close a gap for prescription drug coverage for seniors.
The Senate approved the package earlier in the day. It now goes to Obama to sign.
The votes concluded a yearlong political struggle that tied up lawmakers, dented Obama’s popularity and set the stage for a bitter campaign for control of Congress in November.
“This has been a legislative fight that will be in the record books,” Democratic Senate leader Harry Reid said.
Obama, launching a public relations blitz to sell the new program, mocked his Republican critics and said their promise to make repeal of the law the centrepiece of the congressional campaign would backfire.
“If they want to have that fight, I welcome that fight,” Obama said in Iowa City, Iowa, in his first major speech since signing the law on Tuesday.
“I don’t believe the American people are going to put the insurance industry back in the driver’s seat. We’ve been there already and we’re not going back,” he said.
The overhaul of the $2.5 trillion (1.68 trillion pounds) healthcare system is the most dramatic change in health policy in four decades. It will extend coverage to an estimated 32 million uninsured Americans and bar insurance practices like refusing coverage to those with pre-existing medical conditions.
The final changes approved by Congress on Thursday include an expansion of federal subsidies to make insurance more affordable and more state aid for the Medicaid program for the poor.
They also eliminate a controversial Senate deal exempting Nebraska from paying for Medicaid expansion costs, close a gap in prescription drug coverage for seniors and delay a tax on high-cost insurance plans.
The final package also would extend taxes for Medicare, the federal health insurance program for the elderly, to unearned income. It also includes reform of the student loan program.
Republicans have fought the measure as a costly government takeover of healthcare that would restrict patient choice and drive up insurance premiums.
“This has been a sombre week for the American people. With the stroke of a pen, President Obama signed away another share of Americans’ freedom,” Republican House leader John Boehner said.
But Obama said he would be happy to engage Republicans in a debate over repeal of the law.
“I say go for it,” Obama said, goading his critics. “If these congressmen in Washington want to come here to Iowa and tell small business owners that they plan to take away their tax credits and essentially raise their taxes, be my guest.”
The House approved the overhaul and the companion package of changes on Sunday after a contentious debate, but had to approve the changes again after the Senate parliamentarian ordered two minor provisions on the student loan revamp be removed. The House vote was 220-207.
The parliamentarian ruled the provisions did not meet reconciliation rules requiring they have a budgetary impact.
The Senate’s 56-43 vote on the changes came after Democrats killed about 40 Republican amendments designed to derail the bill or force Democrats into tough political votes before the elections.
As the end of the healthcare debate neared, the Morgan Stanley Healthcare Payor index of health insurers rose 0.4 percent, slightly higher than the broader market. Big insurers UnitedHealth Group rose 0.4 percent, while Aetna increased 0.4 percent.
A second major U.S. manufacturer said the overhaul would cause a huge rise in after-tax costs. Farm equipment maker Deere & Co. said it expected healthcare costs to rise by $150 million this year.
Equipment maker Caterpillar last week estimated the reform would raise its costs by more than $100 million.
White House spokesman Robert Gibbs brushed off the concerns and said the first-year increase occurred because the healthcare law closed an accounting loophole.
“Our bill simply closes the loophole that allows them to deduct that money one time by not counting it as income,” he told reporters on Air Force One.
Additional reporting by Andy Sullivan, Patricia Zengerle, Thomas Ferraro; Editing by David Alexander and Peter Cooney