Senate passes health-care bill, now must reconcile it with House

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Friday, December 25, 2009

Senate Democrats approved landmark legislation just after sunrise Christmas Eve that would transform the nation's health-care system by requiring people without insurance to obtain coverage and protecting those who have it from the most unpopular private insurance practices.

Vice President Biden presided over the 60 to 39 party-line vote, described as a historic milestone by senators on both sides of the aisle. Despite the early hour, Democrats sat alert at their desks, exhausted but exuberant, savoring a victory that had eluded so many of their predecessors. "This is probably the most important vote that every sitting member of the Senate will cast in their tenure here," said Sen. Christopher J. Dodd (D-Conn.), one of the authors of the bill.

The toughest stretch may lie ahead as House and Senate leaders attempt to fuse their separate bills with their different approaches to providing coverage and paying for it. And Republicans vow to make the process as difficult as possible, in hopes of stopping the legislation.

President Obama delayed a family holiday trip to Hawaii until after the 7 a.m. vote was gaveled to a close. "Seven presidents have tried to pass comprehensive health insurance reform, seven presidents have failed" since Theodore Roosevelt proposed universal coverage in 1912, Obama noted in brief remarks before he left the White House. But no effort had ever come this distance.

"We are now finally poised to deliver on the promise of real, meaningful health insurance reform," Obama said. Once the House and Senate merge their bills, he added, "this will be the most important piece of social legislation since the Social Security Act passed in the 1930s and the most important reform of our health-care system since Medicare passed in the 1960s."

The Senate bill passed without a single GOP vote, after a 25-day floor debate marked by biting partisan rhetoric. As Democrats overcame divisions and closed ranks, accepting concessions to push the bill through, Republicans became fierce in opposition. Even Sen. Olympia J. Snowe (R-Maine) -- a moderate courted over many months by Obama -- responded "No," frowning when the Senate clerk called her name.

Republicans made one concession: They allowed the final vote to be moved up from evening to early morning, so senators and staff could travel home to spend Christmas with their families. But Minority Leader Mitch McConnell (Ky.) pledged that the battle will continue when Congress returns in January. "This fight is not over. This fight is long from over," he said. "My colleagues and I will work to stop this bill from becoming law."

The bills' scope is vast, but Democrats are counting on consumer-friendly provisions -- including some that would take effect right away -- as selling points to a skeptical public. In the Senate bill, sick uninsured people with preexisting medical conditions could immediately obtain private coverage through state-based high-risk insurance pools, and insurers could no longer deny coverage to children under age 18 with preexisting conditions. Small businesses with fewer than 25 employees would become eligible for tax credits to purchase insurance for their workers. Adults 26 years old or younger could remain on their parents' policies.

Six months after enactment of the plan, co-payments and deductibles on preventive services, including physical examinations, immunizations, and mammograms, would be eliminated for everyone. Insurers would be barred from dropping beneficiaries when they become sick and from imposing lifetime limits on coverage.

Throughout the nearly year-long debate, Republicans have counted as allies many of the same industry forces that helped to defeat health-care reform in the past. The insurance lobbying group America's Health Insurance Plans warned in a statement Thursday that the Senate bill would result in higher premiums and fewer coverage options. Medical-device manufacturers and home health-care providers fought provisions that would increase their costs. Virtually every major business group denounced reform as a threat to jobs and the health coverage that the majority of Americans receive through their employers.

But Democrats held advantages, too. The White House cut deals with drugmakers and hospital groups, effectively neutralizing two of the most formidable industry blocs. Two other health-care powerhouses, AARP and the American Medical Association, endorsed both the House and Senate bills.

Large Democratic majorities eased passage through both chambers, but to secure the votes needed, Senate Majority Leader Harry M. Reid (Nev.) and House Speaker Nancy Pelosi (Calif.) were forced to concede on major issues. Both bills include restrictions on abortion coverage, stipulations that infuriated liberals but were vital to winning over conservative Democrats. Reid dropped the government insurance option that was sought by liberals in his caucus but opposed by a few key moderates.

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