Senate Democrats vote to bring health bill to floor for debate
REID SEEKS PASSAGE BEFORE CHRISTMAS
Caucus remains bitterly divided over public option

By Shailagh Murray and Paul Kane
Washington Post Staff Writer
Sunday, November 22, 2009

The Senate voted along party lines Saturday night to overcome aRepublican filibuster and bring to the floor a bill that would overhaulthe nation's health-care system.

After days of indecision, the last two Democratic holdouts -- Sens. Blanche Lincoln (Ark.) and Mary Landrieu(La.) -- joined their caucus in supporting a motion to begin debate.The 60 to 39 vote marks a milestone in the decades-old quest forhealth-care reform, President Obama's top legislative priority.

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

The debate is expected to last weeks. Reid is aiming for final passage by Christmas.

The House passed a $1 trillion health bill two weeks ago; the $848billion Senate version represents the work of two committees andhundreds of hours of hearings and deliberations, against a backdrop offervent Republican opposition. But even as Democrats heralded theirvictory, they conceded that it represented the end of the beginning --and not the other way around.

Like Sen. Ben Nelson(D-Neb.), a holdout until Friday, Lincoln and Landrieu said they willpress Reid for further changes to the bill before committing to itsfinal passage. Above all, the Democratic caucus remains bitterlydivided over a government-run insurance option.

Reid quelled an uprising by liberal senators weeks ago by adding apublic option to the legislation. But although he included an opt-outclause for states, some moderates -- including Landrieu and Lincoln --have told Reid they will oppose the Senate bill on final passage unlessthe provision is dropped.

"My vote should in no way be construed by the supporters of thiscurrent framework as an indication of how I might vote on the finalbill," said Landrieu, adding that she also will seek more generous taxcredits for small-business health care.

For Democratic leaders, the weeks ahead are likely to bringadditional concessions. Lawmakers are already requesting changes to thelegislation, raising concerns related to Medicare, abortion andemployer requirements.

To secure support for Saturday's vote, Reid had to agree to a72-hour review period that Lincoln sought after the bill was introducedWednesday night. He added a Medicaid clause worth up to $300 millionfor Landrieu's home state. Although many Democrats pressed Reid toinclude language to end a federal antitrust exemption for healthinsurers, he omitted the repeal to lock down Nelson's vote.

Republicans portrayed the vote as tantamount to an endorsement ofthe underlying bill, or "a vote for higher premiums, cuts to Medicare,and more taxes," as Sen. Lamar Alexander (Tenn.) declared.

"All those people who are concerned about the high cost of health caretoday aren't getting relief under the Democrat plan," said Sen. John Thune (S.D.). "In fact, their lives are going to get much, much worse."

But Democratic leaders said the vote provided a jolt of momentum thatvastly improved prospects for a completed Senate bill before theChristmas break, leaving January for negotiations with the House. Thegoal now is to deliver final legislation to Obama in time for the Stateof the Union address in late January.

Reid requested that senators vote from their chairs, a formalitygenerally reserved for such historic matters as the confirmations ofSupreme Court nominees. Sen. George V. Voinovich (R-Ohio) was not present and did not vote.

Afterward, supporters of health-care reform gathered outside theCapitol to cheer Democratic lawmakers as they left the building. And atearful Vicki Kennedy, widow of Sen. Edward M. Kennedy (D-Mass.), called Reid to applaud his efforts on her late husband's behalf.

"We know not all 60 senators in my caucus agree on every aspect of thisbill," Reid told reporters. "But they agree on the vast, vastmajority."

The Senate bill would provide coverage to 31 million uninsuredAmericans by vastly expanding Medicaid and creating insurance"exchanges" for individuals who do not have access to affordablecoverage through their employers. For the first time, it would requiremost people to carry health coverage, although families with incomes upto 400 percent of the federal poverty level would receive subsidies tobuy policies.

The legislation would also force widespread changes to the insuranceindustry to end discriminatory practices, including the rejection ofcoverage based on preexisting conditions. It would provide newincentives to encourage disease prevention and to institute the mosteffective treatments for chronic conditions such as diabetes andasthma.

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

Even before he released the bill last week, Reid started work onsecuring the votes for Senate passage. He canvassed Democrats inprivate meetings and phone calls, and urged groups of senators withshared interests to work together on amendments. Leadership aides alsodrew up lists of potential Republican amendments to devise howDemocrats would respond.

Along with the three Democratic moderates who have stepped forward,two other senators are likely to become frequent visitors to Reid'soffice in the weeks ahead. Like Nelson, Landrieu and Lincoln,independent Sen. Joseph I. Lieberman(Conn.) opposes the public option but agreed to support the start ofdebate. Unlike the moderate Democrats, Lieberman has statedunequivocally that he would oppose a government insurance plan in anyform.

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 (Maine), the only Republican to support the Senate Finance Committee bill.

Nelson, Landrieu and other moderate Democrats have suggested theycan support an alternative version of the public option proposed bySnowe; it would take effect only if private policies proveunaffordable. Democrats are hopeful they can win her back as the debateadvances and said she has continued to negotiate with Reid. But Snowesaid, "The conversations have to translate into something specific . .. and that hasn't happened."

Staff writer Lori Montgomery contributed to this report.