Brushing aside a White House veto threat, the Republican-controlled House voted Friday to let insurance companies sell individual health coverage to all comers, even if it falls short of the required standards in "Obamacare."
In all, 39 Democrats broke ranks and supported the legislation, a total that underscored the political importance of a controversial issue likely to be front and center in next year's elections for control of Congress.
The overall vote was 261-157 on a measure that supporters said would ease the plight of millions of consumers reeling from cancellation notices. Those cancellations have been arriving from companies despite President Barack Obama's oft-made promise that anyone who liked his plan could keep it. The bill now goes to an uncertain fate in the Senate.
Friday's vote came as Obama arranged a meeting later in the day at the White House with insurance company CEOs, and as the industry and state insurance commissioners began adjusting to an abrupt change in policy he announced a day earlier.
Under the shift, Obama said insurers should be permitted to continue to sell to existing customers individual coverage plans that would be deemed substandard under the health care law. Without the change, many existing plans would have been banned beginning next year, and the president's announcement was an attempt to quell a public and political furor triggered by millions of cancellation notices.
The House measure went one step further. It would give insurance firms the ability to sell individual plans to new as well as existing customers, even if the coverage falls short of the law's requirements.
"For the last six weeks the White House stood idly by ignoring the pleas of millions," said Rep. Fred Upton, R-Mich., chairman of the House Energy and Commerce Committee and lead sponsor of the legislation.
"Our straightforward, one-page bill says, if you like your current coverage, you should be able to keep it. The president should heed his own advice and work with us, the Congress, as the founders intended, not around the legislative process."
But Democrats said the measure was just another in a long line of attacks on the health care bill from Republicans who have voted repeatedly to repeal it.
"It would take away the core protections of that law. It creates an entire submarket of substandard health care plans," said Rep. Henry Waxman of California.
Separately, Obama's top health care official said Friday that the number of people who want to keep policies that were canceled because of the federal health overhaul is relatively small but that those people have valid concerns that the administration is addressing.
"For those people it's real," Health and Human Services Secretary Kathleen Sebelius said during a visit to a Detroit health clinic. She said of the president, "The last thing he wants is people to be without coverage."
Under the overhaul, insurance plans would have to conform to numerous conditions to qualify. Among them, they would have to accept all customers, regardless of pre-existing conditions, would be limited in additional premiums they could charge on the basis of age and could not cap lifetime benefits. They also would have to include coverage in a wide range of areas — doctor and hospital care for adults and children, laboratory services, preventive coverage and prescription drugs.
In a veto threat Thursday night, the White House accused Republicans of seeking to "sabotage the health care law," and said their measure would allow "insurers to continue to sell new plans that deploy practices such as not offering coverage for people with pre-existing conditions, charging women more than men, and continuing yearly caps on the amount of care that enrollees receive. "
The cancellation issue is only part of the woes confronting the president and his allies as they struggle to sustain the health care law.
Obama has repeatedly apologized for a dismal launch of www.healthcare.gov , which consumers in 36 states were supposed to use beginning on Oct. 1 to sign up for new coverage. The website is so riddled with problems that the administration disclosed earlier this week that fewer than 27,000 signups have been completed — a number that Republicans noted is dwarfed by the flood of cancellations issued due to the law.
Compounding the administration's misery, the poor quality of the website has made it that much harder for consumers receiving cancellation notices to shop for alternative plans.
It is unclear what, if anything, the administration is prepared to do to alleviate the threat of a break in coverage for those consumers.
In addition, there already are signs of resistance among state insurance commissioners, who would have to agree to allow Obama's proposed change to take effect. At the same time, industry officials and commissioners alike warn that premium prices could rise beginning with 2015 coverage plans if the changes go into effect.
The Democratic opposition to the House measure was based in part on a fear that opening cheaper substandard plans to all comers could wind up driving premiums higher for the rest of the population.
The concern they express is that younger, healthier Americans would be attracted to the cheaper coverage, rather than seek out a plan that conforms with the Obamacare requirements.
Younger, healthier individuals are generally less expensive to cover for an insurer, and the more they shun the government-run insurance exchanges set up under the law, the higher the premiums could be for the relatively older, sicker customers who shop there.
This story has been updated.