WASHINGTON — The Senate's 60-39 vote early Thursday to overhaul the nation's health care system — President Barack Obama's top 2009 domestic priority — moves the nation closer than it's ever been to a dramatic change in how Americans get medical care.
“We may not completely cure this crisis today or tomorrow,” said Senate Majority Leader Harry Reid, D-Nev., “but we must start toward that end.”
At the White House, Obama declared that, “With today’s vote, we are now incredibly close to making health insurance reform a reality in this country. These are not small reforms. These are big reforms.”
Despite all the compromises — and more to come as the Senate and House of Representatives try to reconcile their differing versions of the legislation — Obama put a positive spin on the effort. If the changes become law, he said, they’d be the biggest social reform since the creation of Social Security in the 1930s.
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Fifty-eight Democrats and two independents — but none of the Senate’s 40 Republicans — voted for $871 billion bill, which would require most Americans to obtain health insurance, would provide federal aid for those who have difficulty paying for coverage and would bar insurers from denying policies to people with pre-existing conditions.
The bill now must be merged with a version the House passed last month. Negotiators are likely to begin closed-door talks next month, aiming to finish a final compromise bill in time for Obama’s State of the Union address, probably in late January.
Some major differences need to be resolved before any bill can emerge from the House-Senate conference, however.
The House bill puts strict limits on federal funding of abortion. The Senate is less restrictive.
The House wants a government-run insurance plan, or public option. The Senate opted instead to push a federally supervised system of multi-state, privately run insurance plans.
The House wants to impose a 5.4 percent income-tax surcharge on individuals who earn $500,000 a year or more and couples who make more than $1 million, starting in 2011, a change that would begin to restore some of the Bush-era tax cuts.
The Senate, however, prefers a 40 percent excise tax on more expensive employer-sponsored insurance plans and a 0.9 percentage point increase in the 1.45 percent Medicare tax on the wealthy.
Democratic leaders and the White House are confident that they can find common ground, and they say they see plenty already. Insurance exchanges, or marketplaces, would be created in which consumers could shop for policies, for instance. Companies no longer could charge higher rates because of gender, and they'd be limited in how much more they could charge older consumers.
Interest groups, however, quickly signaled Thursday that they’d fight for their causes.
“Specific provisions in this legislation will increase, rather than decrease, health care costs; reduce coverage options; and disrupt existing coverage for families, seniors and small businesses, particularly between now and when the legislation is fully implemented in 2014,” said Karen Ignagni, the president of America’s Health Insurance Plans, an industry group.
Other powerful interests were also ready.
“This morning the Senate has brought us closer to meaningful health care reform than we have ever been before,” said Barry Rand, the chief executive officer of AARP, which represents seniors.
Democrats know that they’re in for a fight among themselves, and they've tried hard to read from the same script for weeks: that whatever final bill emerges will be only a start, one that they said could be expanded and refined in the years ahead.
Obama didn’t discuss the concerns Thursday — even among his own party’s critics — about insurance premiums rising, new taxes on benefits or private employers dropping certain coverage. He didn’t mention any deadlines, and he repeated Democrats’ talking points that if the bill becomes law, insurers no longer could refuse coverage to the ill or dump ailing patients, and it could reduce the federal budget deficit.
The scene at the Capitol was historic and at times surreal, as lawmakers arrived on a dark, icy, 26-degree morning. Reid and Senate Republican leader Mitch McConnell of Kentucky made brief remarks, and at 7 a.m. sharp, senators took the unusual step of voting from their desks.
The bill passed at 7:15 a.m., about 10 minutes before sunrise in Washington, as lawmakers met for the 25th straight day.
As Vicki Kennedy, the widow of Massachusetts Democratic Sen. Edward Kennedy, who spent much of his legislative life pushing for health care change until he died in August, watched from a balcony gallery, Sen. Robert Byrd, D-W.Va., the 92-year-old dean of the Senate, cast his vote by gently saying, “This is for my friend, Ted Kennedy.”
Afterward, Vicki Kennedy said, “We still have steps to go, but to be in a position here, the day before Christmas, where both the House and Senate have passed such monumental legislation is . . . truly historic. It’s something my husband fought for his entire public career.”
After the Senate vote, Obama called Kennedy’s widow, as well as a dozen Democratic senators, but no Republicans, according to the White House. He also called David Turner, an Arkansas man with insurance woes who sat with first lady Michelle Obama when the president addressed a joint session of Congress earlier this year.
The day had its lighter moments. Reid at one point voted no. The chamber erupted in laughter; he smiled and changed his vote.
It was a bitter moment, though, for the Republican Party, whose efforts to delay the vote resulted in the Senate’s first Christmas Eve session since 1963. Even at the end, McConnell was unrelenting in his opposition.
“This debate was supposed to produce a bill that reformed health care in America,” he said in his closing argument. “Instead, we’re left with party-line votes in the middle of the night.”
Whatever the final result, Thursday’s vote isn’t the end of a long battle over health care that’s nearly a century old. The 1912 Progressive Party platform championed by former President Theodore Roosevelt urged “the protection of home life against the hazards of sickness, irregular employment and old age through the adoption of a system of social insurance adapted to American use.”
In 1945, President Harry Truman proposed what most historians view as the beginning of the serious legislative health care effort.
“Our new Economic Bill of Rights,” Truman said, “should mean health security for all, regardless of residence, station, or race, everywhere in the United States.”
For decades, presidents from both parties tried mightily. Medicare, the government’s insurance plan for people 65 and older and some others with disabilities, began in 1965, but though it proved popular, it couldn’t provide momentum for universal health care.
Democrats made the issue a cornerstone of their 2008 presidential campaign. With a popular president and control of 60 of 100 Senate seats and 258 of the 435 House seats, leaders saw 2009 as a rare opportunity to pass legislation.
Deadlines came and went, however. Originally, Obama wanted a bill by August, as Republicans balked and Democratic centrists were wary of the public option and the bill’s cost.
Thursday's vote came only after Senate leaders agreed to last-minute deals with centrists. Sen. Ben Nelson, D-Neb., got tougher language limiting federal abortion funding, as well as a pledge of more Medicaid aid for his state. Sens. Mary Landrieu, D-La., and Blanche Lincoln, D-Ark., were pleased with additional help for small business.
Liberals weren’t happy, but went along.
“The bill still delivers meaningful reform,” said Sen. Russ Feingold, D-Wis. “and the cost of inaction is simply too high.”
What’s important, Democrats said, is that, as Sen. Christopher Dodd, D-Conn., a key health care architect, said, “This is the beginning of a process, not the end.”
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