Senate passes health care bill in historic vote

UPDATED:

In a vote resonating with history, Senate Democrats early Christmas Eve morning passed their version of health care reform, advancing the issue further than ever before in the nation’s history and setting up a bruising stretch-run to get a final bill to President Obama next year.

“It’s about people, it’s about life and death in America. It’s a question of morality, of right and wrong,” said Senate Majority Leader Harry Reid, Nevada Democrat. “It’s about human suffering, and given the chance to relieve this suffering, we must take this chance.”

The party-line 60-39 vote is the midway point for the bill. It must now be reconciled with a very different House measure. Major sticking points remain, including how to treat federal payments for abortions, whether to force insurance companies to compete with a government-run public health plan and which taxes to raise to pay for the changes.

Both sides in those debates have drawn lines they say they will not cross. But Mr. Reid, and his House counterpart Speaker Nancy Pelosi, have been remarkably successful in maneuvering their bills through the legislative minefield, particularly in the Senate where Mr. Reid needed to wheel and deal to keep all 60 members of his caucus on board and defeat repeated filibuster attempts.

The Senate bill would extend health coverage to 31 million more people by 2019 at a cost of $871 billion — though thanks to tax increases and spending cuts, it could end up saving the government money. It requires individuals to buy insurance, offers subsidies to low- and middle-income families to buy coverage and forces insurance companies to stop denying coverage on many grounds, such as pre-existing conditions.

In full Senate tradition, senators voted ceremonially from their desks, one after another intoning “Aye” or “No” as the clerk called their names.

“This is for my friend, Ted Kennedy — Aye!” said Sen. Robert C. Byrd, West Virginia Democrat, honoring the Massachusetts senator and staunch universal health care supporter who died this summer, leaving the Senate to work on the issue as a legacy to him.

But Republicans predicted the vote would resonate loudly outside the Senate chamber.

“I guarantee you, the people who voted for this bill are going to get an earful when they finally get home,” Senate Minority Leader Mitch McConnell, Kentucky Republican, warned the Senate in the moments before the vote.

“An earful of wonderment and happiness,” Mr. Reid retorted.

Democrats have been trying to expand health care coverage since President Truman. The most recent attempt was early in the Clinton administration, when legislation died without seeing floor votes in either chamber.

Thursday’s vote marked the high-point of the charge — never before has legislation passed both chambers.

“These are not small reforms, these are big reforms,” Mr. Obama said at the White House after the vote. “If passed, 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 lobbying on the measure, which was already intense, will only grow.

Already the American Medical Association, which praised Thursday’s vote, said the bill needs fixes to stop medical payment boards from meddling with doctors’ decisions, while the U.S. Chamber of Commerce, which opposed passage, said the upcoming negotiations between the House and Senate offer a chance to “start over.”

Republicans have been monolithic in opposing the measure, calling it a “historic mistake” and arguing it falls short on Mr. Obama’s principles of allowing people to keep their insurance if they like it, and of reducing the long-term portion of gross domestic product that goes to health care spending.

Sen. Olympia J. Snowe, the Maine Republican who had been courted by Mr. Obama as a potential supporter and who voted for a bill in committee, gripped the edges of her desk as she voted against the new version on the floor.

And with her votes earlier this week arguing that the measure is unconstitutional, she has probably sealed off any ability to sign onto a bill later no matter what the changes. Republicans point to polls that show a clear majority of voters oppose what Democrats are doing on health care — though Democrats say when they get a chance to explain themselves, those polls will turn around.

“I believe that the negativity that leader McConnell and others have continually displayed on the floor has peaked, and now, when people learn what’s actually in the bill and all the good it does, it’s going to become more and more popular,” said Sen. Charles E. Schumer, New York Democrat.

The Democrats who wrote the House’s version of health care legislation praised the Senate for acting, but those plaudits masked the difficulty of reconciling the two bills.

Sen. Ben Nelson, Nebraska Democrat, and Sen. Joe Lieberman, Connecticut independent, who are linchpins of the Senate deal, have said they cannot accept the public health option that liberal House Democrats have demanded be in the bill.

And Mr. Nelson and Rep. Bart Stupak, Minnesota Democrat, have insisted pro-life language preventing federal taxpayers’ money from going to pay for abortions be included in any final bill — something other Democrats in both chambers say they’ll try to lift.

An early morning motorcade delivered Vice President Joseph R. Biden Jr. to the Capitol to preside over the vote, which lasted a little more than 10 minutes — possibly the quickest roll call vote the Senate held all year. Mr. Reid had the goof of the day. When the clerk called his name he initially voted “No,” setting the entire chamber laughing. The embarrassed Democratic leader corrected himself, and the clerk pointedly repeated his “Aye” vote.