Senate Democrats passed a landmark health care
bill in a climactic Christmas Eve vote that could define President
Barack Obama's legacy and usher in near-universal medical coverage
for the first time in U.S. history.
The 60-39 vote on a cold winter morning capped months of arduous
negotiations and 24 days of floor debate. It also followed a
succession of failures by past congresses to get to this point.
Vice President Joe Biden presided as 58 Democrats and two
independents voted "yes." Republicans unanimously voted "no."
The tally far exceeded the simple majority required for passage,
but clearly showed the philosophical split between Democrats and
Republicans over how American health care should be delivered.
And that acrimony is expected to persist as the Senate's bill
gets merged with legislation passed by the House. That has to happen
before Obama can sign a final bill in the new year.
There are significant differences between the two measures but
Democrats say they've come too far now to fail. Both bills would
extend health insurance to more than 30 million more Americans.
The bill's passage will offer Obama a bright end to an often
rocky year that began with huge hopes following his election
victory. His public approval level now hovers around 50 percent as
he copes with high unemployment, increasing violence in Afghanistan
and the divisive health care debate.
Obama delayed his Christmas vacation in Hawaii until the Senate
vote, a sign of its importance to his presidency. The legislation
will likely shape the 2010 congressional elections and possibly
Obama's 2012 re-election bid.
Obama quickly hailed Senate passage of the bill and said his
government is now "finally poised to deliver on the promise" of
overhauling a troubled system.
He noted that presidents since Theodore Roosevelt in 1912 have
been trying unsuccessfully to overhaul medical care.
Obama also repeated his theme that the bill will help end
long-criticized insurance industry practices, such as denying
coverage for pre-existing conditions.
The Senate bill "includes the toughest measures ever taken to
hold the insurance industry responsible," Obama said.
Vicki Kennedy, the widow of the late Massachusetts Sen. Edward
Kennedy, who made health reform his life's work, watched the vote
from the gallery.
"This morning isn't the end of the process, it's merely the
beginning. We'll continue to build on this success to improve our
health system even more," Majority Leader Harry Reid said before
the vote. "But that process cannot begin unless we start today ...
there may not be a next time."
After passage, House Minority Republican Leader John Boehner
assailed the bill.
"Not even Ebenezer Scrooge himself could devise a scheme as
cruel and greedy as Democrats' government takeover of health care,"
the Ohio Republican said in a statement.
He complained that the legislation would increase health coverage
costs for families and small businesses, raise taxes during a
recession and cut into federal health care benefits for the elderly.
"It's no coincidence that the more the American people learn
about this monstrosity, the more they oppose it," Boehner said.
The legislation would ban the insurance industry from denying
benefits or charging higher premiums on the basis of pre-existing
medical conditions. The Congressional Budget Office predicts the
bill will reduce deficits by $130 billion over the next 10 years, an
estimate that assumes lawmakers carry through on hundreds of
billions of dollars in planned cuts to insurance companies and
doctors, hospitals and others who treat Medicare patients.
For the first time, the government would require nearly every
American to carry insurance, and subsidies would be provided to help
low-income people to do so. Employers would be induced to cover
their employees through a combination of tax credits and penalties.
The legislation costs nearly $1 trillion over 10 years and is paid
for by a combination of taxes, fees and cuts to Medicare.
Some liberal Democrats have not been enthusiastic about the
Senate bill because they don't believe it goes far enough, leaving
some 24 million people uninsured.
And there are no plans for a government-run national health care
system that would cover all Americans. Even a more modest proposal
to have a government-run health plan compete with private insurers
had to be stripped from the Senate bill in the face of opposition
from moderate Democrats.
Negotiations between the House and Senate to reconcile
differences between the two bills are expected to begin as soon as
next week.
