Senate health-care reform bill passes another hurdle

By Paul Kane and Shailagh Murray
Washington Post Staff Writer
Tuesday, December 22, 2009;10:30 AM

The Senate cleared a set of key procedural hurdles on President Obama'shealth-care legislation early Tuesday with more party-line votes,continuing the effort to pass the $871 billion bill before Christmas.

All 60 members of the Democratic caucussupported votes that set up a third and final 60-vote hurdle forWednesday, while all 39 Republicans in the chamber voted to block theaction.

With tempers continuing to simmer on the Senate floor, Majority Leader Harry M. Reid(D-Nev.) pleaded for cooler heads to prevail in the holiday season. "Iwould hope that everyone would go back to their gentlemanly ways," Reidsaid, invoking the plea of Los Angeles resident Rodney King after riotserupted in 1992 following the trial in his police beating case.

"Let's just all try to get along."

Minority Leader Mitch McConnell(R-Ky.) gave his first public indication that Republicans, faced withcertain defeat in their effort to block the legislation, would consideryielding some of the debate time that will follow the Wednesdayafternoon vote.

By rule, Republicans could force another 30 hours of debate beforefinal passage of the historic legislation, which probably would mean noroll-call vote until after 9 p.m. Christmas Eve. But McConnellacknowledged that he and Reid were "working on an agreement that wouldgive certainty" to when that final vote would occur, a signal thatsenators might not have to wait until late Thursday night to finish upthe first Dec. 24 session in 46 years.

It was the second time in five days that the Senate -- now in its23rd straight day of legislative action, all of which has includeddebate on health care -- has convened in the wee morning hours to holdvotes. In addition to the votes Tuesday, which began at 7:30, and a6:45 a.m. vote Saturday, there were two votes that began shortly after1 a.m. -- on a defense bill Friday, and on the health-care packageMonday.

On Tuesday, Sen. James Inhofe(R-Okla.) was the only senator absent. His opposition to thelegislation is widely known and his vote would not have affected theoutcome.

All three votes Tuesday were strictly party line, 60-39. One of thevotes formally inserted Reid's last-minute amendments, which includedthe final compromises needed to secure the unanimous support of hiscaucus, into the nearly 2,500-page legislation. Another vote clearedthe filibuster hurdle on the new, complete package. A final filibuster vote, known as a cloture motion, needs to be cleared Wednesday afternoon before the Senate can move to final consideration of the bill.

Lacking the votes to block the bill, Republicans continued to heapscorn on the many concessions made to wavering Democrats in the questto advance the package.

Sen. David Vitter (R-La.) took to the floor to lambaste Sen. Mary Landrieu(D-La.) for securing better payments from the federal government fortheir state's Medicaid program, which could add up to $300 million.Some have called that side deal the "Louisiana Purchase," but Vitter'sspeech was titled the "Louisiana Sellout," a particularly sharpcritique of his home-state colleague.

On Monday, Republican PartyChairman Michael S. Steele accused Democrats of "thumbing their noseand flipping the bird to the American people." Conceding that theSenate bill is virtually unstoppable, Steele said in a conference callwith reporters: "I intend to have my foot on the throats of theDemocrats on this issue and hold them accountable." Democrats seekingreelection in 2010, he warned, "can look for their pink slips."

Reid responded by telling reporters he was "disappointed" bySteele's remarks, calling them "crass and such a terrible example forthe youth of this country."

But Reid defended the long list of revisions to the bill, which were needed to secure the backing of moderate Democrats such as Sen. Ben Nelson(Neb.). Those changes contained additional Medicaid funding forspecific states including Nebraska, exemptions for certain insurancecompanies and tighter restrictions on abortion coverage. "There are 100senators here, and I don't know that there's a senator that doesn'thave something in this bill that isn't important to them," Reid toldreporters. "If they don't have something in it important to them, thenit doesn't speak well of them."

The majority leader compared the legislation to a defense bill, typically thick with earmarks, many benefiting specific companies. "That's what legislation's all about," said Reid. "It's the art of the compromise."

Senate Democratic leaders received good news Monday when theAmerican Medical Association endorsed the legislation. The groupgenerally has supported the Democrats' reform effort but had raisedconcerns throughout the year-long drafting process.

AMA President-elect Cecil B. Wilson stood alongside Democraticleaders and praised the Senate for bringing "us close to the finishline on health-system reform."

Wilson applauded Reid's decision to drop a tax on elective cosmeticsurgery, replaced in the final bill with a levy on tanning-salonservices. The Senate bill also would increase payments to primary-carephysicians and general surgeons in rural and underserved areas, withoutcutting payments to other doctors, Wilson noted. A proposed physicianenrollment fee for Medicare was dropped.

But Wilson signaled other concerns that he said the AMA wouldaddress if the bill advances to a House-Senate conference in January.Those issues include the scope of powers given to a proposed Medicarepayment board, proposed as a way to rein in costs in the insuranceprogram for seniors. Wilson also questioned quality-improvement andMedicare data-release initiatives that physicians have resisted.

And Wilson said the AMA is counting on Democratic Senate leaders tofollow through with their pledge to change the Medicare physicianpayment system, which makes doctors lobby each year to prevent deepcuts in reimbursements. "We will continue to work closely with them toget that solution," he said.

Staff writer Perry Bacon Jr. contributed to this report.