WASHINGTON — Senate Democrats, without a vote to spare, pushed forward a bill to overhaul the U.S. health care system, but a divisive debate still lies ahead and there is no assurance the measure — as written — will win approval in the upper chamber of the Congress.
In a rare weekend session, the Senate voted 60-39 to move the health care reform legislation to the floor for a full debate, expected to begin after lawmakers return from the Thanksgiving holiday recess. The 60 votes — a three-fifths majority — were the minimum needed under Senate rules to overcome Republican legislative maneuvers to prevent the bill from even being debated by the full Senate.
All 58 Senate Democrats and two independents voted to advance the bill. Republican Sen. George Voinovich of Ohio was the only senator not to vote.
The legislation would extend coverage to roughly 31 million Americans without health insurance, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.
The United States, with a population exceeding 300 million, is the only developed nation that does not have a comprehensive national health care plan. The government provides coverage for the poor and elderly, but most Americans rely on private insurance, usually received through their employers.
The House of Representatives approved its version of the bill earlier this month on a near party line vote of 220-215. Majority Leader Harry Reid, a Democrat, has said he wants the Senate to pass the measure by year’s end. From there, the Senate and House bills would go to what is known as a conference committee where selected members of each chamber would meld the two versions of the overhaul legislation. Each house would then need to approve the final bill before it could be sent to President Barack Obama for his signature.
The president has made revamping health care the key plank in his domestic policy agenda, and Republicans have been fighting to block passage. They believe a defeat on the issue could cripple the administration early in Obama’s first term.
Saturday’s vote was hailed as a victory for Obama, but the legislation’s final passage is far from certain. And the heated debate continued on Sunday morning television news programs.
“I don’t want to fix the problems in our health care system in a way that creates more of an economic crisis,” Sen. Joe Lieberman, a Connecticut independent, said.
Lieberman and three Democratic moderates — Sens. Ben Nelson of Nebraska, Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas — agreed to advance debate on the bill despite having reservations about the legislation. Each has said they might not support subsequent votes on the bill unless changes are made.
Of particular contentiousness to these moderates is a provision in Reid’s legislation for a “public option” that sets up a government-run program to sell insurance in competition with private companies, with individual states allowed to opt out of it. Critics say the public option would open the way for an eventual government takeover of the health care system.
Voicing mainstream Democratic frustration with the potential holdouts, Sen. Sherrod Brown of Ohio warned Democratic leaders not to make too many concessions, particularly on the public option.
“I don’t want four Democratic senators dictating to the other 56 of us and to the rest of the country — when the public option has this much support — that [a public option is] not going to be in it,” said Brown.
Democratic Sen. Debbie Stabenow of Michigan said, meanwhile, that health care cost reductions for employers would save 3.5 million jobs.
Democratic Sen. Arlen Specter of Pennsylvania declared the measure would save the country $800 billion over the coming 20 years.
Republican senators were not buying those arguments.
Republican Sen. Lamar Alexander of Tennessee predicted the measure would collapse under its own weight during debate. And Republican Sen. Kit Bond of Missouri called the Democratic-sponsored measure a “scam.”
In the final minutes of Saturday’s daylong session, Reid accused Republicans of trying to stifle a historic debate the country needed.
“Imagine if, instead of debating whether to abolish slavery, instead of debating whether giving women and minorities the right to vote, those who disagreed had muted discussion and killed any vote,” he said.
The Republican leader, Sen. Mitch McConnell of Kentucky, said the vote was anything but procedural — casting it as a referendum on the bill itself, which he said would raise taxes, cut the government’s Medicare insurance program for the elderly, and create a “massive and unsustainable debt.”
Saturday’s vote marked a major victory for Reid and the White House in a year-end drive to enact the most sweeping changes to the U.S. health care system in a half-century or more. President Bill Clinton’s push for health care reform in the 1990s never got to a vote on its merits.
At the White House, press secretary Robert Gibbs issued a statement saying the president was gratified by the vote, which he says “brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance, and extending quality health coverage to those who lack it.”
The Senate legislation would require most Americans to carry insurance and provide subsidies to those who could not afford it. Large companies could incur costs if they did not provide coverage to their work force. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage to those with preexisting medical conditions.
Congressional budget analysts put the legislation’s cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.
At its core, the legislation would create insurance exchanges beginning in 2014 where individuals, most of them lower income and uninsured, would shop for coverage. The bill sets aside hundreds of billions of dollars in tax credits to help those earning up to 400 percent of poverty, $88,200 for a family of four.
To finance the expanded coverage, Reid proposed higher taxes as well as cuts totaling hundreds of billions of dollars in projected Medicare payments.
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