WASHINGTON — Landmark health care legislation backed by President Barack Obama has passed its sternest Senate test, overcoming Republican delaying tactics on a 60-40 vote that all but assures its passage by Christmas.
“Let’s make history,” said Sen. Tom Harkin, D-Iowa, shortly before the bill’s supporters demonstrated their command of the Senate floor in an extraordinary holiday-season showdown.
In the run-up to the vote, the escalation in rhetoric was remarkable on both sides of an issue that has divided the two parties for months.
“This process is not legislation. This process is corruption,” said Sen. Tom Coburn, R-Okla., referring to the flurry of dealmaking that enabled Majority Leader Harry Reid, D-Nev., and the White House to lock in the 60 votes needed to approve the legislation.
Democratic Sen. Sheldon Whitehouse of Rhode Island responded in near-biblical terms. In a speech on the Senate floor, he said Republicans have embarked on a “no-holds-barred mission of propaganda, obstruction and fear. . . . There will be a reckoning. There will come a day of judgment about who was telling the truth.”
The legislation represented the culmination of a year’s work for Democrats, pressed by Obama to remake the nation’s health care system.
Democrats said Nebraska Sen. Ben Nelson’s announcement Saturday that he would vote for the bill gave them the support they needed.
Nelson came in for strong criticism from Republicans in Washington, who complained that he had won favorable treatment for his home state’s Medicaid program. In a bit of political theater, they sought to open the bill up to extend it to all 50 states, but Democrats objected.
Nelson’s agreement to an abortion- related change in the bill drew criticism from Nebraska Right to Life, a longtime supporter, and the state’s Catholic bishops, who issued a statement that they were “extremely disappointed” in him.
Asked whether Republicans could prevent the bill’s passage, Sen. John McCain, R-Ariz., said, “Probably not. But what we can do is continue winning the battle of American public opinion.”
Democrats hoped Republicans would relent in the face of a 60-vote majority, but if GOP critics choose to do so, they could delay a final vote on the bill until early Christmas Eve.
The House has already passed legislation, and attempts to work out a compromise are expected to begin in the days after Christmas.
The Senate legislation is predicted to extend coverage to more than 30 million Americans who lack coverage and would ban industry practices such as denial of insurance on the basis of pre-existing medical conditions. The Congressional Budget Office said it would reduce deficits by about $132 billion over a decade and possibly much more in the 10 years that follow.
At its core, the legislation would create an insurance exchange where consumers could shop for affordable coverage that complies with new federal guidelines. Most Americans would be required to purchase insurance, with subsidies available to help families making up to $88,000 in income afford the cost.
In a bow to Senate moderates, the measure lacks a government-run insurance option of the type that House Democrats placed in their bill. Instead, the estimated 26 million Americans purchasing coverage through new insurance exchanges would have the option of signing up for privately owned, nonprofit nationwide plans overseen by the same federal-agency office that supervises the system used by federal employees and members of Congress.
The full extent of Reid’s maneuvering was still unclear.
Nelson won numerous changes, including tougher restrictions on abortion coverage and an estimated $45 million in federal Medicaid funds, enough to completely cover his state’s costs of complying with an expansion of the program mandated by the bill.
Vermont and Massachusetts also won additional Medicaid funds; plastic surgeons were persuasive in their bid to strip out a proposed tax on elective plastic surgery; hospitals in the Dakotas, Wyoming and Montana won additional Medicare funds; and there was more money for hospitals in Hawaii to treat the uninsured.
Winners and losers
WASHINGTON — The sweeping legislation designed to remake the U.S. health care system also affects more narrow interests. Here are some winners and losers:
Winners
Libby, Mont.: Residents of this town of 2,900 suffering from asbestos-related illnesses from a now-closed mineral-mining operation now have access to Medicare benefits, thanks to a last-minute insertion by Finance Committee Chairman Max Baucus, a Montana Democrat.
Cosmetic surgeons: Fended off a 5 percent tax on procedures.
Nebraska, Louisiana, Vermont and Massachusetts: These states are getting more federal help with Medicaid than other states. In the case of Nebraska — represented by Sen. Ben Nelson, who is providing the critical 60th vote for the legislation to pass — the federal government is picking up 100 percent of the tab of a planned expansion of the program, in perpetuity. Vermont and Massachusetts get temporary increases in the federal share of their Medicaid tabs. In Louisiana, moderate Democratic Sen. Mary Landrieu negotiated $100 million for 2011 before announcing her support for the legislation.
Beneficiaries of Medicare Advantage plans — the private managed-care plans within Medicare — in Florida: Hundreds of thousands of them will have their benefits grandfathered in thanks to a provision tailored by Sen. Bill Nelson, D-Fla., that also affects a much smaller number of seniors in a few other states.
Community health centers: They got $10 billion more in the revised bill, thanks to advocacy by Sen. Bernie Sanders, I-Vt.
A handful of physician-owned hospitals being built around the country — including one in Bellevue, Neb. — that would be permitted to get referrals from the doctors who own them, avoiding a new ban in the Senate bill that will apply to hospitals built in the future. Chalk up another win for Ben Nelson.
AARP, the lobby for elderly people. The new bill has about $1 billion in extra Medicaid payments to states that provide visiting nurses and other in-home or community services to prevent low-income people from needing to be admitted to hospitals. In House-Senate bargaining, AARP also is expected to win a top priority: a full closing of the so-called “doughnut hole,” the gap in Medicare’s coverage of prescription drugs.
Doctors and hospitals in Montana, North Dakota, South Dakota, Utah and Wyoming, who will get paid more than providers elsewhere under formulas in the bill.
Loser
Tanning salons: The bill places a 10 percent tax on indoor tanning services, replacing the cosmetic-surgery tax.
Progressives: They had to give up on their dream of a new government-run insurance plan so Democratic leaders could lock down the necessary votes from moderates.
People making more than $200,000 a year: A proposed 0.5 percent increase in the Medicare payroll tax was bumped up to 0.9 percent in the latest version, putting the tax at 2.35 percent on income over $200,000 a year for individuals, $250,000 for couples.
Generic-drug makers: They fought unsuccessfully to block 12 years of protection that makers of brand-name biotech drugs — expensive pharmaceuticals made from living cells — will get against generic would-be competitors.
The Associated Press
