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Senators ready to cast second of three votes on health-care bill

By Shailagh Murray
Washington Post Staff Writer
Tuesday, December 22, 2009; A08

Senators prepared to cast the second of three procedural votes early Tuesday to end the health-care debate, but Republicans showed little indication that they were ready to relent in a standoff that could push passage of the legislation to the latter part of Christmas Eve.

Senate Democrats secured a crucial victory shortly after 1 a.m. Monday on a party-line 60 to 40 vote to end a Republican filibuster of the bill, embarking on a long -- but now apparently obstacle-free -- march to a final roll call. As the chamber waited for the clock to wind down to a second vote, scheduled for 7 a.m. Tuesday, the American Medical Association officially endorsed the measure, while Democratic leaders defended the dealmaking that has brought the $871 billion legislation to the brink of passage.

Lacking the votes to block the bill, Republicans heaped scorn on the many concessions made to wavering Democrats in the quest to advance the package. GOP critics warned that support for the effort could mean the demise in 2010 of vulnerable incumbents, including Sens. Blanche Lincoln (D-Ark.) and Christopher J. Dodd (D-Conn.).

Republican Party Chairman Michael S. Steele accused Democrats of "thumbing their nose and flipping the bird to the American people." Conceding that the Senate bill is virtually unstoppable, Steele said in a conference call with reporters: "I intend to have my foot on the throats of the Democrats on this issue and hold them accountable." Democrats seeking reelection in 2010, he warned, "can look for their pink slips."

Senate Majority Leader Harry M. Reid (D-Nev.) told reporters he was "disappointed" by Steele's remarks, calling them "crass and such a terrible example for the 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 for specific states including Nebraska, exemptions for certain insurance companies and tighter restrictions on abortion coverage. "There are 100 senators here, and I don't know that there's a senator that doesn't have something in this bill that isn't important to them," Reid told reporters. "If they don't have something in it important to them, then it 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, a former senior member of the Senate Appropriations Committee. "It's the art of the compromise."

While GOP opponents turned up the heat, Senate Democratic leaders held a news conference Monday afternoon to tout the AMA's endorsement. The group generally has supported the Democrats' reform effort, but had raised concerns throughout the year-long drafting process.

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

Wilson applauded Reid's decision to drop a tax on elective cosmetic surgery, replaced in the final bill with a levy on tanning-salon services. The Senate bill also would increase payments to primary-care physicians and general surgeons in rural and underserved areas, without cutting payments to other doctors, Wilson noted. A proposed physician enrollment fee for Medicare was dropped.

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

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

Staff writer Perry Bacon Jr. contributed to this report.

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