As insurance groups and employer groups pressed for changes in the House health bill, the House Rules Committee agreed to send the bill to the floor.

Members of the committee voted 6-4, along party lines, to schedule 4 hours of floor debate on H.R. 3962, the Affordable Health Care for America Act bill, starting at 9 a.m. Saturday.

For coverage of the House floor debate and vote, look here.

A copy of the report describing the floor debate rules is available here.

H.R. 3962 would require health insurers to sell coverage on a guaranteed issue, mostly community-rated basis and attempt to improve the quality of the risk pool by requiring most people to have health coverage. Individuals who failed either to meet the proposed coverage ownership requirements or pay penalties could go to prison for up to 5 years.

Rep. Bart Stupak, D-Mich., will get a chance to offer an AHCAA bill amendment that would prohibit private insurers from using federal funds to pay for abortions. The amendment also would prohibit health plans sold through the proposed health insurance exchange system from paying for abortions.

House Minority Leader John Boehner, R-Ohio, was given time to present an alternative version of H.R. 3962 that relies on mechanisms such as risk pools, reinsurance programs and association health plans to reform the health insurance market.

House leaders created H.R. 3962 by combining separate health bills produced by the House Energy and Commerce, Education and Labor, and Ways and Means committees. The Rules Committee decides which bills go to the House floor and how the bills will be considered.

There are 4 Republicans on the Rules Committee and 9 Democrats. Republicans offered dozens of amendments to H.R. 3962, including some that would protect the health savings account program, and some that would restore provisions added earlier to the House Energy and Commerce version, but voting on the proposed amendments began after midnight, and Rules Committee Democrats rejected all of the amendments with quick, party-line votes.

Republicans on the committee complained that the Democrats had shut them out, and about the fact that the Democrats had given them only a short time to read and react to a 1,990-page bill. The final version of the bill is about 1,000 pages longer than the previous versions. The addition of 1,000 extra pages is not simply a “de minimis” change, said Rep. David Dreier, R-Calif., the highest ranking Republican on the committee.

The Rules Committee hearing, which started at 2 p.m. and lasted until after 1 a.m., was the only chance for a House committee to debate the final version of a bill that could affect one-sixth of the U.S. economy, Dreier said.

Rep. James McGovern, D-Mass., shrugged off the criticisms.

“We gave you a turn,” McGovern said. “We ended up with more and more people becoming uninsured. We need to go in a different direction.”

RULES COMMITTEE DEBATE

Rep. Pete Sessions, R-Texas, said that the AHCAA bill would increases taxes by more than $700 billion over 10 years, that it could shift millions of Americans who now have group health coverage into Medicaid or other unsustainable government health programs, and that it could eliminate more than 4.7 million jobs.

Ways and Means Chairman Charles Rangel, D-N.Y., countered that the AHCAA bill would create jobs, by expanding the number of doctors and nurses needed to care for all of the newly insured people.

Sessions also complained about an addition to the bill that appears to permit a handful of doctor-owned hospitals to escape from new restrictions on doctor-owned hospitals. Rangel said the addition was made to help a few doctor-owned hospitals that handle an unusually large percentage of Medicaid beneficiaries; Sessions cited a press report suggesting the change had been made in an effort to drum up votes for the bill.

Many Rules Committee talked about the problems their businesses or relatives have had with getting and keeping health coverage. Rep. Ed Perlmutter, D-Colo., told colleagues that his own daughter has epilepsy and is classified as uninsurable. “She didn’t ask to have epilepsy,” he said, adding that he believes that denying her health coverage is immoral and violates the 14th amendment to the Constitution.

Rep. Dave Camp, R-Mich., said the risk pools in the Republican alternative would help people with pre-existing conditions, and he said the Republican alternative would be just a first step, not the final word on health reform.

Rep. Mark Kirk, R-Ill., told Perlmutter that, because the AHCAA bill would tightly restrict the difference between rates for the oldest insureds and the youngest, coverage in a post-AHCAA world would probably be more expensive than the coverage she now has, even though has a difficult time getting insurance.

Throughout the evening, Republicans marveled at the fact that, by imposing a 2.5% tax on relatively high-income people who decide to go without insurance, the AHCAA bill could subject people who choose not to pay lead to prison sentences for some uninsured people who skip paying a proposed failure-to-own-health-coverage penalty.

Advocates of the provision say that requiring young, healthy people to buy health coverage may make the insured population healthier and make it easier for insurers to coverage on a guaranteed issue basis.

Around 9:30 p.m., Sessions held up a copy of the bill and shook it. “Five years in prison for someone who does not at any time duirng the taxable year maintain acceptable health insurance,” Sessions said. “And I thought we lived in a free country.”

As the committee debated the bill and the amendments, many lawmakers and staffers looked exhausted. Sometime around midnight, Rep. Alcee Hastings, D-Fla., blasted Republicans for overloading staffers in the House legislative counsel’s office with extra amendment drafting work.

THE AMENDMENTS THAT DIED IN THE RULES COMMITTEE

Lawmakers proposed many amendments to H.R. 3962.

One rejected amendment, Number 121, would kept the bill from interfering with health savings accounts, and another, Number 69, would have ensured the future of high-deductible health plans. Number 70 would have let small businesses, associations and nonprofits buy health coverage through association health plans that would be free from state health insurance mandates.

Rep. Michael Burgess, R-Texas, an obstetrician, said that he has been startled to hear colleagues suggesting that getting more people into Medicaid, in Medicaid’s current form, is a good way to provide access to health coverage. Many providers refuse to participate in the program because reimbursement rates are so low, he said.

Burgess introduced Amendment 22, which could have required Medicaid plans to pay reimbursement rates equal to 75% of what a state’s employee plan or the Federal Employees Health Benefit Plan pays. He also introduced several other amendments designed to improve state Medicaid provider networks before Medicaid plans undergo health reform-related expansion.

Several lawmakers proposed amendments that could have required the president, members of Congress to get their health coverage from the public option plan.

GROUPS REACT

Both the American Medical Association, Chicago, and the AARP, Washington, have endorsed H.R. 3962.

The National Association of Health Underwriters, Arlington, Va. – a group that helped change the tone of the health reform debate when it participated in a Capitol Hill “fly-in” this summer – says H.R. 3962 breaks President Obama’s health reform campaign promise.

“The campaign promise for health care reform has been that if you like your current health insurance, you can keep it,” NAHU Chief Executive Janet Trautwein says in a statement. “Unfortunately, H.R. 3962 will break this promise by driving up the cost of coverage for millions of American families and dismantle the employer market.”

Once the system is broken, repairing the damage may be nearly impossible, Trautwein says.

The public plan that would be created by H.R. 3962 “would simply shift health care costs onto private payers — and undermine the private insurance system in the process,” Trautwein says.

But NAHU still wants to work with members of Congress and the Obama administration on coming up with sensible health reforms, Trautwein says.