Senate votes on party lines to begin debate on health bill

WASHINGTON — The Senate voted along party lines Saturday night to overcome a Republican filibuster and bring to the floor a bill that would overhaul the nation’s health care system.

After days of indecision, the two final Democratic holdouts — Sens. Blanche Lincoln of Arkansas and Mary Landrieu of Louisiana — joined the rest of their caucus in supporting a procedural motion to begin debate. The 60-39 vote marks a milestone in the decades-old quest for health care reform that was reignited by President Barack Obama’s election.

“The road to this point has been started many times,” Senate Majority Leader Harry Reid, D-Nev., said before the vote. “It has never been completed.”

Reid is aiming for final passage before Christmas.

The House passed a $1 trillion health bill two weeks ago. The $848 billion Senate version represents the work of two committees and hundreds of hours of hearings and deliberations, against a backdrop of fervent Republican opposition.

But even as Democrats heralded their victory, they conceded that it represents the end of the beginning, not the other way around.

Still divided on public option

Like Sen. Ben Nelson, D-Neb., a holdout until Friday, Lincoln and Landrieu said they will push for further changes to the bill before committing to its final passage. Above all, the Democratic caucus remains bitterly divided over a government insurance option.

Reid quelled an uprising by liberal senators weeks ago by adding a public option to the legislation. Although he included an opt-out clause for states, some moderates — including Landrieu and Lincoln — have told Reid they will oppose the Senate bill on final passage unless the provision is dropped.

For Democratic leaders, the weeks ahead are likely to bring costly concessions. Lawmakers are already requesting changes, raising concerns related to Medicare, abortion and employer requirements.

Republicans portrayed the action Saturday night as tantamount to an endorsement of the underlying bill, or “a vote for higher premiums, cuts to Medicare and more taxes,” as Sen. Lamar Alexander of Tennessee declared.

“All those people who are concerned about the high cost of health care today aren’t getting relief under the Democrat plan,” said Sen. John Thune of South Dakota. “In fact, their lives are going to get much, much worse.”

Concessions to wrangle votes

To secure support for the vote Saturday, Reid had to agree to a 72-hour review period that Lincoln sought after the bill was introduced Wednesday night. He added a Medicaid clause worth up to $300 million for Landrieu’s home state. Although many Democrats pressed Reid to include language to end a federal antitrust exemption for health insurers, he omitted the repeal to lock down Nelson’s vote.

“My vote should in no way be construed by the supporters of this current framework as an indication of how I might vote on the final bill,” said Landrieu, adding that she also will seek more generous tax credits for small-business health care.

But Democratic leaders said the vote provided a jolt of momentum that vastly improved prospects for a completed Senate bill before the Christmas break, leaving January for negotiations with the House.

Their goal now is to deliver final legislation to Obama in time for the State of the Union address in late January.

Reid requested senators vote from their chairs, a formality generally reserved for historic matters such as confirmations of Supreme Court nominees. Sen. George Voinovich, R-Ohio, was not present and did not vote.

Supporters of health care reform gathered outside the Capitol afterward to cheer Democratic lawmakers as they left the building. The White House issued a statement of approval, and a tearful Vicki Kennedy, widow of Sen. Edward Kennedy, D-Mass., called Reid moments after the vote to applaud his efforts.

Subsidies to buy coverage

“We know not all 60 senators in my caucus agree on every aspect of this bill,” Reid told reporters. “But they agree on the vast, vast majority.”

The Senate bill would provide coverage to 31 million uninsured Americans by vastly expanding Medicaid and creating insurance “exchanges” for individuals who do not have access to affordable coverage through their employers.

For the first time, it would require most people to carry health coverage, although families with incomes up to 400 percent of the federal poverty level would receive subsidies to buy policies.

The legislation also would force widespread changes to the insurance industry to end discriminatory practices, including the rejection of coverage based on pre-existing conditions. It would provide new incentives to encourage disease prevention and to institute the most effective treatments for chronic conditions such as diabetes and asthma.

On the revenue side, the Senate bill would extract about $400 billion in cost savings from Medicare and Medicaid, and impose an excise tax on the most generous health care policies. It would raise payroll taxes for high earners and levy a 5 percent tax on elective cosmetic surgery.

Along with the three Democratic moderates who have stepped forward, two other senators are likely to become frequent visitors to Reid’s office in the weeks ahead. Like Nelson, Landrieu and Lincoln, independent Sen. Joseph Lieberman of Connecticut opposes the public option but agreed to support the start of debate.

Unlike the moderate Democrats, Lieberman has stated unequivocally that he would oppose a government insurance plan in any form.

That leaves Reid with two options. Either he must persuade liberal lawmakers to give up the provision, or he must win back Olympia J. Snowe of Maine, the only Republican to support the Senate Finance Committee bill.

Democrats are hopeful they can win her back as the debate advances and said she has continued to negotiate with Reid. But Snowe said, “The conversations have to translate into something specific . . . and that hasn’t happened.”