Senate passes historic, if diluted, health reform bill

Senate Democrats on Thursday approved the best health care reform bill they could manage: a sweeping $871 billion proposal designed to extend coverage to tens of millions of uninsured Americans and slow the growth of runaway costs.

Senate Majority Leader Harry Reid, D-Nev. (WDCpix)

It was at once a monumental achievement, which if signed into law would represent the most expansive overhaul of the nation’s dysfunctional health care system in generations, and a disappointment to many liberals who’d hoped the reforms would go further to rein in the same medical-services industries most responsible for the skyrocketing expenses.

The tally was 60 to 39, with every member of the Democratic caucus (including two Independents) voting in favor of the measure and every Republican present voting against it.

Not surprisingly, Iowa’s senators split on the issue, with Democrat Tom Harkin in support and Republican Chuck Grassley voting against.

“This is for my friend Ted Kennedy,” 92-year-old Sen. Robert Byrd (D-W.Va.) said just before his vote, a reference to the late Massachusetts Democrat and health reform champion who passed away over the summer.

Senate leaders must now combine their bill with the one passed last month by the House, which, despite broad similarities, strays on several key issues, including its creation of a controversial public insurance option.

The rare Christmas Eve vote came after months of acrimonious debate over how Congress should approach health care reform. The saga first pitted Democrats against Republicans, but later — when it became clear that no Republicans would support the bill — saw liberal Democrats and their moderate colleagues doing battle over the most contentious provisions of the 2,074-page bill. The Republicans, who said the bill represented an expensive government takeover, were effective in slowing the pace of the legislation, but were helpless to prevent passage once the Democrats united behind it.

For the Democratic faithful, that unification came at a price. To secure 60 votes, party leaders had to bow to the demands of two caucus moderates — Sens. Joe Lieberman, I-Conn., and Ben Nelson, D-Neb. — who were threatening to join a Republican filibuster otherwise. With no margin for desertions, Democratic leaders were forced to concede several of their legislative priorities in the process. To win Lieberman, they dropped their plans to create a government-run insurance option to compete with private companies — a program that many liberal policy experts consider vital for controlling rising premium costs — and to lower the age of Medicare eligibility to 55. For Nelson, they tacked on language restricting abortion coverage under subsidized plans operating on newly proposed insurance marketplaces, called exchanges. That provision has been roundly attacked by reproductive rights groups, who argue that it will restrict women’s access to comprehensive health services.

Both concessions set the stage for a fight with House Democrats when leaders of the chambers meet next month to marry the two bills. Already, some House liberals are claiming that Senate Democrats bent too far.

Rep. Louise Slaughter, D-N.Y., the chairman of the House Rules Committee and also a leader of the Congressional Pro-Choice Caucus, blasted the Senate bill Wednesday as “not worthy of the historic vote that the House took a month ago.”

The Senate’s decision to eliminate the public option — combined with federal insurance subsidies and a mandate requiring most Americans to buy health insurance from private companies — is simply a gift to the insurance industry, Slaughter claimed, echoing the message coming from other liberal critics since the compromise with Lieberman was announced.

“I do not want to subsidize the private insurance market,” Slaughter wrote on CNN.com. “[T]he whole point of creating a government option is to bring prices down.”

It’s not the only wrinkle that will need ironing out. There are also significant discrepancies in how the chambers fund their separate bills; how they approach illegal immigrants; how broadly they would expand Medicaid; and what they propose to do with the Children’s Health Insurance Program, to name just a few.

Still, Democrats in the White House and the Senate cheered Thursday’s vote as a historic step toward covering the estimated 46 million Americans who currently lack health insurance. Senate Majority Leader Harry Reid (D-Nev.) said the bill is imperfect, but added that it nonetheless represents a giant step toward jumpstarting the “process” that is health-care reform.

“How much longer can we afford to put this off, or ask the uninsured for their patience?” Reid asked just before the vote. “Until health care costs consume not just a sixth of our economy, but a third, or a half? Until premiums consume a more than half of a family’s income? We certainly don’t have the luxury of waiting until America becomes the only developed nation on earth where you can die for lack of health insurance — we already bear that blemish.”

Republicans, meanwhile, continued to attack the legislation as a bloated government intervention that will raise taxes and steal consumer choice. Senate Minority Leader Mitch McConnell. R-Ky., said Thursday that the bill doesn’t cut costs, as Democrats claim. “It doesn’t do what it was supposed to do,” he said.

McConnell also warned supporting Democrats that they’ll get “an earful” from constituents when they go home for the holidays. “They know there is widespread opposition to this monstrosity,” McConnell said.

Neither side of the debate claims that the nation’s health care system isn’t in need of an overhaul. Indeed, health policy experts on and off of Capitol Hill have warned for years that the rising costs of health care services, which far outpace both inflation and wages, are threatening to swamp the entire economy. And the numbers support their case. This year health care spending is projected to top $2.5 trillion, representing almost 18 percent of the gross domestic product. By 2017, the figure is expected to jump to 20 percent. The question all along has been how to slow that growth without compromising either patient care or the health-services research needed to uncover new medical technologies and procedures.
Democrats are hoping to merge the House and Senate bills quickly to allow President Obama to sign the legislation into law before giving his State of the Union address, which is expected to take place late next month. That timeline, however, is far from guaranteed, considering that Senate lawmakers aren’t scheduled to be back in Washington until Jan. 19.

Even then, the debate over health care will be far from over. One of the first bills that Congress will have to take up following Obama’s speech will be one addressing the 21-percent cut in Medicare physician payments. Although lawmakers provided a two-month fix to prevent those cuts from taking effect on Jan. 1, a permanent solution was too expensive to fit into their larger health reform bills.

That, however, is for another day. Today, the Democrats are reveling over their hard-fought legislative victory.

Mike Lillis covers Congress for The Washington Independent, a Center for Independent Media site.