By GREG HITT
WASHINGTON—Democrats and independents closed ranks Saturday and voted to move forward with debate on landmark legislation that would overhaul the nation's health system and extend health insurance to 31 million Americans.
The 60-39 Saturday vote came after a handful of undecided senators—centrist Democrats Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas—signaled their readiness to begin action on the $848 billion package crafted by Democratic leaders.
The vote was a validation of Senate Majority Leader Harry Reid's strategy of building consensus first among party loyalists rather than reaching across the aisle to Republicans, a move that would have forced the Nevada Democrat to pare ambitions and push a more modest bill.
"They shouldn't be afraid to debate," said Sen. Reid, who was celebratory after the vote. "This is the United States Senate."
Republicans, who were threatening a filibuster to stall action, said the legislation would cost too much. "Move over, Bernie Madoff," said Sen. Christopher Bond (R., Mo.). "Tip your hat to a trillion-dollar scam."
In the final tally, all 58 Democrats, and the two independents allied with the party, joined together to move forward on the bill. The roll call was conducted with senators sitting at their desks, a rarely used show of decorum that underscored the significance of the vote. Thirty-nine Republicans were opposed. One Republican, Sen. George Voinovich of Ohio, didn't vote.
Sixty votes are needed in the 100-member Senate to end a filibuster. The vote set the stage for two to three weeks of debate in December and perhaps more in January, in a struggle that is sure to color the 2010 fight for control of Congress.
Mr. Reid said he took a call in the Senate cloakroom immediately after the vote from the widow of the late Sen. Edward Kennedy, the Massachusetts Democrat who devoted much of his career to the cause of health care. "Ted would be happy," Mr. Reid said, adding he sees the "finish line" ahead for the bill.
The push in the Senate follows approval in the House Nov. 7 of companion legislation that would overhaul the health system.
Republicans, who are vowing to use every tactic available to slow action and frustrate the White House's top domestic priority, portrayed the vote as an endorsement of the legislation. It includes new taxes and cuts in Medicare payments to health-care providers, in addition to an expansion of Medicaid, the federal-state health program for the poor, and new government subsidies to help lower- and middle-income people buy insurance.
Republicans beseeched wavering moderate Democrats not to fall into line, hoping to derail the bill and force Mr. Reid to deal more directly with the minority party. "Today in the Senate, we don't need 40 Democrats to stand up for what's right. We need just one," said Sen. Mike Johanns (R., Neb.).
But they couldn't get it.
Beginning Friday, the final undecided Democrats starting coming off the fence. First was Nebraska Democrat Ben Nelson, who said he didn't want to deny the voters in his state a voice on the issue. "The Senate owes them a full and open debate," he said.
A few hours later, Sen. Lincoln of Arkansas took to the Senate floor. She also voiced concerns, noting she didn't favor the proposed government-run insurance plan "as it is written" in the bill. But Sen. Lincoln said she didn't intend to hold up debate, and complained Republicans – who are gunning for her defeat next year -- were simply trying to "revive their political party" by opposing the initiative.
"Although I don't agree with everything in his bill, I have concluded that I believe it is more important that we begin this debate to improve our nation's health-care system for all Americans, rather than simply drop the issue and walk away," she said. "That is not what people sent us here to do."
Of all the wavering senators, Sen. Lincoln was under the greatest pressure. She faces a tough re-election battle next year, and polls show the health legislation is not popular in her conservative state. Republican strategists swiftly blasted her Saturday for giving Democratic leaders the "60th vote" to take up the bill.
"Obviously, the pressure from the left wing of her party finally got to Blanche Lincoln," said Amber Wilkerson Marchand, a spokeswoman for the National Republican Senatorial Committee, the campaign arm of Senate Republicans. She said "the people of Arkansas will have an opportunity to hold" Sen. Lincoln "accountable when they cast their ballots next November."
Though the economy is emerging again as a major issue for voters, Democratic leaders in both chambers of Congress, as well as the White House, are heavily invested in enacting health legislation, intending to make good on a major Democratic promise from the 2008 campaign.
The outcome of debate in the Senate – where the push for health-overhaul legislation died in 1994 -- is the biggest uncertainty facing Democratic leaders and the White House. Not only do Republicans have big leverage to shape debate, but Democrats are not united on details, and difficult negotiations lie ahead on issues like the government-run insurance plan and aid to small businesses, among other things.
The legislation would create a national "exchange" where small businesses and individuals could purchase insurance. It would require most people to carry health insurance or face a penalty of up to $750 per person.
Under the bill, employers with more than 50 workers who don't offer insurance would be required to make a payment to the government to defray the taxpayers' cost of insuring the workers. Additionally, insurers would be barred from engaging in a range of practices – such as denying insurance because of pre-existing conditions -- that critics say have led to gaps in coverage across the country and created turmoil in family budgets. The bill would also create a government-run insurance plan, while giving states the option not to participate.
The nonpartisan Congressional Budget Office estimates the bill would reduce the deficit by $130 billion over the next decade, in part due to cuts in Medicare payments to health-care providers but also because of a range of new taxes. They include new fees on drug makers and medical-device makers, a tax on high-value insurance plans, and higher Medicare payroll taxes for families making more than $250,000 a year.
"Senators who support this bill have a lot of explaining to do," said Senate Minority Leader Mitch McConnell (R., Ky.). "Americans know that a vote to proceed on this bill is a vote for higher premiums, higher taxes, and massive cuts to Medicare. That's a pretty hard thing to justify supporting."