In a 60-39 vote on strictly partisan lines, the Senate sent the $848 billion health care bill to the floor for debate after the Thanksgiving break, but not before a clutch of moderates served notice that they couldn’t back the bill in its current form.
One key provision – for a government-run insurance plan that would allow states to opt-out of coverage – effectively died in the Senate chamber Saturday, as the last two Democratic holdouts demanded changes to the bill. s
“I am opposed to a new government administered public health care plan as a part of comprehensive health care reform, and I will not vote in favor of the proposal that has been introduced by Leader Reid as it is written,” said Sen. Blanche Lincoln (D-Ark.), the last Democrat to commit to a vote for opening debate. Two hours earlier, Sen. Mary Landrieu (D-La.) had said much the same thing.
Their comments signal that weeks of negotiations remain on a bill Obama once hoped to have on his desk by Christmas – and even raised the prospect that splits in the party over the public option, abortion and other aspects of the bill could scuttle passage altogether.
That timetable has always been worrisome to the White House because it would push the delicate final passage of the legislation into an election year, with Democrats skittish about voter backlash for a plan that draws decidedly mixed reviews in the polls.
Senate Democrats, though, are pushing for roughly three weeks of floor debate in December that could complete work on a bill by Christmas. That would be followed by a “mini-conference” over the holidays between Democratic House and Senate leaders – who would hope to have a bill to present to their caucuses in time for a mid-January vote.
“We’re going to have some long days, we’re going to have weekends,” Senate Health Committee Chairman Tom Harkin said. "We’re going to have three weeks. That means we’ll finish on the 23rd of December. And maybe, actually, a little before then – actually the weekend before then.”
The Democratic celebration in the Senate was subdued. There were a few scattered "yays" and applause when the tally was announced. Senate Majority Leader Harry Reid (Nv.) accepted handshakes.
Sen. John McCain (R-Az.) made light of the vote as it was going down.
"What is going to happen? What is going to happen?" McCain said, rubbing his hands together in mock anticipation from his seat on the Senate floor. "Oh, this is so tense."
His comments could be heard in the gallery. Sen. Susan Collins (R-Maine), sitting next to him, smiled and buried her head in her hands.
"We can see the finish line, but we're not there yet," Reid told reporters after the vote.
"The road ahead is a long stretch. But we can see the the finish line...we have the momentum...we're going to keep this process moving, I have no doubt," said Reid, who conceded that "We know not all 60 senators in my caucus agree on every aspect of this bill.”
Asked about the moderates’ opposition to a public option, Reid reiterated his support for a strong public option and said Schumer and Sen. Tom Carper (D-Del.) were working with Landrieu on a compromise that everyone in the caucus could accept.
Schumer spokesman Brian Fallon, though, said that while the New York senator is open to compromise, "no such talks have yet taken place, and there is not any compromise at hand beyond what Leader Reid has already inserted into the bill."
There's still at least a chance that Democrats won't be able to bridge the divides inside their own party on the public option, abortion, how to pay for reform and other issues that could prevent a final deal from coming together.
“Absolutely not," said Sen. Sherrod Brown of Ohio, one of the more liberal members of the Democratic Caucus, when asked if he was open to further discussion of the public option. “We’ve compromised four times now.”
“Four members of the Senate aren’t going to tell the other 55 what to do on these issues,” he said.
Other progressives signaled a willingness to deal.
“We expected it all along that we continue to negotiate on the public option," said Sen. Debbie Stabenow (D-Mich.).
Sen. Sheldon Whitehouse (D-R.I.) echoed Stabenow.
"I, for one, am willing to work with folks," he said. "We need to make sure we can pass this bill, and if takes flexibility on either side, nobody should have their mind closed to that flexibility."
Even if Reid can assuage the moderates in his caucus by pulling his bill to the right without losing liberal support, he’ll face bruising negotiations with House Speaker Nancy Pelosi, who is intent on keeping intact major provisions of her far more left-leaning bill. Pelosi’s version of the public option, for instance, is far more open-ended than Reid’s.
And then there are the Republicans, who vowed Saturday to try to block health reform from ever leaving the Senate.
Democrats are expecting multiple Republican amendments on hot-button issues such as medical malpractice, immigration and abortion. The challenge for Reid is finding a way to shield his members from taking politically difficult votes and to prevent the passage of a GOP amendment that could sink the entire deal.
Reid has promised a “free-wheeling, wide-open amendment process,” said Senate Majority Leader Mitch McConnell (R-Ky.), who added that Republicans are likely to attempt to filibuster each amendment, meaning Reid would have hold together his 60 votes time and again.
"The battle has just begun," McConnell added. "The American people are asking us to stop this bill, and we are going to do anything and everything we can to prevent this measure from becoming law."
Still, Reid declared victory for the bill and predicted that he could get a version of health reform passed and sent for Obama’s signature. The 8 p.m. vote was a significant milestone in a health care reform debate that has stretched over decades.
Reid’s bill would cover 94 percent of all Americans by creating a public health insurance option, increasing subsidies for those who can’t afford insurance and requiring individuals to own insurance. Reid would pay for this by raising taxes on insurers who offer so-called Cadillac tax plans, bumping up Medicare taxes for the wealthy and creating a “Botox tax” on cosmetic surgery.
Aside from the public option, there are other big differences with the House bill, including how to pay for reform. The House counts on a tax on couples earning more than $1 million a year to pay for it – an idea that has zero support in the Senate.
But as it has for months, the public option remained the greatest obstacle to passing a bill.
Two of those who voted yes on Saturday – Sen. Ben Nelson (D-Neb.) and Sen. Joseph Lieberman (I-Conn.) -- have already said they’d join a filibuster of the current bill and both have raised objections to the public option.
The vote Saturday was likely to resurrect interest in the idea of using a “trigger” that would kick in a public plan if states lack enough affordable health care options. That plan has the support of a Republican Sen. Olympia Snowe (R), one of the few GOP senators who might cross party lines to back the bill, though she voted against cloture on Saturday.
Some Democrats – including Obama – have signaled a preference for the trigger to bridge deep divides in the party, Landrieu, too, spoke in favor of the trigger.
“Our caucus knows this is a real serious issue for us from the beginning,” said Landrieu, who has been in discussions with other centrists. “A third are for the public option, a third are adamantly against and a third are in the middle. I am adamantly against but would consider a principled compromise because I understand this is one of the issues we have to find a solution for or it could blow up the whole effort.” Landrieu also was unapologetic in describing how she sought more help for her state in the health reform negotiations – even saying reports that she got $100 million more in Medicaid dollars for Louisiana were false. It was really $300 million, she said.
“I’m proud to have asked for it. I’m proud to have fought for it, and I will continue to. That is not the reason I’m moving to the debate,” Landrieu said.
Lincoln instead spoke of de-coupling the public option from a federal government role – apparently a reference to a plan being crafted by Carper for a national health insurance plan that would be run by a not-for-profit firm, not by the government.
Lincoln, who is facing a tough reelection fight in 2010, also put fellow Democrats on notice about the political stakes in her race -- saying she’s already faced some $3.3 million in ads trying to sway her vote on the bill, from the left and the right.
And she laid down a laundry list of concerns, most of which also are shared by her fellow centrists: that the bill must protect seniors on Medicare, make insurance more affordable for small businesses, enhances competition with private insurers, and must not increase the deficit – and do it all without a public option.
For a day at least, Reid could breathe a sigh of relief, having passed a major test of his leadership by holding together 58 Democrats and 2 independents on a vote to open for debate a bill that doesn’t pass muster with many of them.
In sometimes heated floor remarks, Republicans called the $848 billion bill a budget-busting, tax-raising monstrosity that would hurts seniors, small business and families.
McCain said Reid was guilty of budget gimmickry by cutting Medicare and raising taxes in the first year of the bill, 2010, but not starting many of the services until 2014. “I don’t think Americans really understand the scam that’s going on here,” McCain said. “I think Bernie Madoff went to jail for this kind of behavior.”
And both sides sparred over the nature of Saturday’s vote – with Democrats saying it’s merely a chance for debate to begin and Republicans saying it’s a back-door endorsement of the $848 billion plan.
The missing vote was Ohio Republican George Voinovich, an opponent of the bill who announced that he would skip the vote for a thirtieth anniversary celebration of his election as Cleveland mayor.
"The Democrat plan would make life harder for the vast majority of Americans. It raises their taxes, it raises their health care premiums, it cuts their Medicare and drives millions off the private insurance they currently have,” McConnell said.
Democrats accused them of scare-mongering and said the bill is a sensible and long-overdue fix to a badly broken health care system.
“The key elements of this health care reform bill, I repeat: reduces short-and-long term debt, expands coverage, promotes choice and competition, reforms the insurance market, improves quality of care,” Reid said.
Ted Kennedy's widow, Vicki, phoned Reid in the Senate cloakroom immediately after the vote.
She was emotional, as was he, Reid said.
"I will remember the call always, always," the majority leader told reporters. "We both said Ted would be happy."
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Yesterday, Sen. Al Franken (D-MN), acting on the orders of the Senate leadership, refused to grant Sen. Joe Lieberman (I-CT) “
![[Senate Majority Leader Harry Reid (D., Nev.) speaks at a news conference following the Senate's 60-39 vote to bring health-care-reform bill to a full debate on the floor of the Senate.]](http://s.wsj.net/public/resources/images/OB-EY197_health_F_20091121211050.jpg)
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