It is a well-known fact that the Republicans have been receiving their instructions from the health insurance companies, who heavily fund their re-election campaigns and who do not want a health bill at all.  Revision means forcing them to insure millions of marginally healthy people as well as those with bad health records (pre-existing conditions). 

This time, the House passed the Senate bill without any changes.  Healthcare became law when the president signed it on Tuesday, March 23. 

To fulfill promises made to House lawmakers, reconciliation to the main healthcare bill was passed first by the Senate, then the House.  Republicans offered 40 amendments to the bill, in a final desperate attempt to change the bill enough to force the House to vote again, but Democrats steadily rejected each amendment. 

In the end, Republicans voted unanimously against the reconciliation, threatening to take the issue to their election campaigns to win enough seats to repeal healthcare.   

Every November, the entire House and one-third of the Senate are re-elected.  Many of the Republican amendments were specifically aimed for votes that could be made to sound embarrassing for Democratic lawmakers running for re-election. 

The main points of the healthcare legislation include:

• New consumer protections for denial of coverage based on pre-existing conditions (effective for adults in 2014, but children in 2010).  Adults currently with pre-existing conditions uninsured for a minimum six months can enroll in a temporary high-risk pool with subsidized premiums (effective June 2010).
• Lifetime coverage limits—eliminated (effective 2010).
• Coverage dropped after a sickness—prohibited. 
• Waiting period for coverage limited to 90 days.
• Child coverage under parents plan—extended to age 26 (effective September 2010).
• Individuals under age 30 without insurance can purchase catastrophic coverage on the new health insurance exchanges. 
• Coverage will be portable for employees that leave a job.
• Health insurance exchanges (effective 2014) will be created with minimum standards and competing plans available to pool risks for small businesses and uninsured individuals.
• New policies issued after September 2010 will fully cover preventive care visits and screenings.  Doctors will get paid for seeing uninsured patients they are now treating for free.
• Businesses with fewer than 25 employees will be eligible for tax credits for up to 35 percent of health insurance premiums paid.  Pooling risks with other small businesses will stabilize costs. 
• Employers will disclose the cost of workers health insurance on their W-2 (starting 2011)
• Medicare beneficiaries with the Part D drug benefit who fall into the coverage gap (“donut hole”) will receive a $250 rebate in 2010. Starting 2011, they will receive a 50% discount on brand-name drugs, with the gap closing by 2020. 
• Medicare members will not pay more than three times the average premium paid by a healthy younger person, even though middle-aged Americans use more than five times the amount of health services.   
• Medicare Advantage plan reimbursements will be cut back from benefits currently offered, which give members more choices than standard Medicare plans and cost about 15 percent more than the average Medicare plan. Some of these cuts would be offset by a new deal with drug companies to sell medications not covered by Medicare at half price.
• Medicaid will be expanded, making it available to an estimated 16 million more people with incomes up to one-third above the poverty income line, including adults without dependent children.  Community health centers will receive enhanced funding.
• Subsidies provided over the next 10 years for low to moderate-income people without employer health benefits will enable about 32 million uninsured to buy plans on health-insurance exchanges.
• Medical expense tax deduction threshold will be raised to 10% of adjusted gross income (effective 2013). Seniors (age 65 and older) would be able to claim an itemized deduction at the current standard of 7.5% (through 2016).
• Flexible spending health account rules remain the same for three years. A $2,500 cap on contributions (with cost-of-living adjustments) appears likely to go into effect in 2013.
• Health savings account penalty for withdrawing funds for nonqualified medical expenses increases to 20% (effective 2011).
• All citizens and legal residents will be required to have health insurance.  Subsidies will be on an income sliding scale up to 4 times the poverty line.  
• Fines will be imposed on those who decline health insurance (starting 2014); the higher of $95 or 1% of income, growing to $695 or 2.5% of income (2016).
• For individuals with earnings greater than $200,000 and married couples earning more than $250,000 the Medicare payroll tax will rise in the next two years to 2.35%. A new 3.8% Medicare tax will be applied to investment income (including interest, dividends and capital gains) that exceed those thresholds.
• For job-based “Cadillac” plans (annual premiums exceeding $10,200 for individuals or $27,500 for families), plan administrators will be taxed 40 percent (effective in the next few years). Limits are higher for certain high-risk jobs and retirees. 
• Fees will be imposed on insurance and pharmaceutical companies and medical device manufacturers (starting 2014). 
• Health plans will be required to report the proportion of premium dollars spent on clinical services, quality, and other costs and provide rebates to consumers.
• A new federal body will be created that would have power to block insurers from raising rates.
• Higher taxes will reduce the federal deficit by nearly $140 billion over 10 years. 

It does not include a public option to compete with private insurers.  

Read the bill at The Health Care and Education Affordability Reconciliation Act of 2010