Health care bill clears first Senate hurdle

The 60-39 vote cleared the way for a bruising, full-scale debate beginning after Thanksgiving on the legislation, which is designed to extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny or dilute benefits and curtail the growth of spending on medical care nationally.

The spectator galleries were full for the unusual Saturday night showdown, and applause broke out briefly when the vote was announced. In a measure of the significance of the moment, senators sat quietly in their seats, standing only when they were called upon to vote.

In the final minutes of a daylong session, Majority Leader Harry Reid, D-Nev., accused Republicans of trying to stifle a historic debate the nation needed.

"Imagine if, instead of debating whether to abolish slavery, instead of debating whether giving women and minorities the right to vote, those who disagreed had muted discussion and killed any vote," he said.

North Carolina Republican Sen. Richard Burr spoke Saturday against the bill.

“This bill costs too much. It taxes too much. It doesn't reform health care and it leaves 24 million Americans uncovered,” Burr said.

Burr's Democratic counterpart, Sen. Kay Hagan, stressed Saturday that the legislation aims to help Americans.

“How many people do we know who have a condition like diabetes, asthma, a woman who's had a C-section that is therefore denied from getting health insurance? We’ve got to be sure that we correct this and that's what this bill does,” Hagan said.

For all the drama, the result of the Saturday night showdown had been sealed a few hours earlier, when two final Democratic holdouts, Sens. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, announced they would join in clearing the way for a full debate.

"It is clear to me that doing nothing is not an option," said Landrieu, who won $100 million in the legislation to help her state pay the costs of health care for the poor.

Lincoln, who faces a tough re-election next year, said the evening vote will "mark the beginning of consideration of this bill by the U.S. Senate, not the end."

Both stressed they were not committing in advance to vote for the bill that ultimately emerges from next month's debate.

Of particular contentiousness to moderates is a provision for the government to sell insurance in competition with private companies, subject to state approval - a part of Reid's bill expected to come under significant pressure as the debate unfolds.

Even so, their announcements marked a major victory for Reid and the White House in a year-end drive to enact the most sweeping changes to the nation's health care system in a half-century or more.

At the White House, press secretary Robert Gibbs issued a statement saying the president was gratified by the vote, which he says "brings us one step closer to ending insurance company abuses, reining in spiraling health care costs, providing stability and security to those with health insurance, and extending quality health coverage to those who lack it."

The legislation would require most Americans to carry insurance and provide subsidies to those who couldn't afford it. Large companies could incur costs if they did not provide coverage to their workforce. The insurance industry would come under significant new regulation under the bill, which would first ease and then ban the practice of denying coverage on the basis of pre-existing medical conditions.

Congressional budget analysts put the legislation's cost at $979 billion over a decade and said it would reduce deficits over the same period while extending coverage to 94 percent of the eligible population.

At its core, the legislation would create insurance exchanges beginning in 2014 where individuals, most of them lower income and uninsured, would shop for coverage. The bill sets aside hundreds of billions of dollars in tax credits to help those earning up to 400 percent of poverty, $88,200 for a family of four.

Dr. Darren Sommer, with the North Carolina chapter of Million Med March, said Congress has not taken into consideration the medical community’s opinions on health care reform.

“What we're doing is we're taking the same high-cost health care and we're just expanding it to everybody. What we need to do is lower the cost of health care for everybody, and then provide coverage, so that every patient is properly covered,” Sommer said.

The House approved its version of the bill earlier this month on a near party line vote of 220-215, and Reid has said he wants the Senate to follow suit by year's end. Timing on any final compromise was unclear.

All 58 Senate Democrats and two independents voted to advance the bill. All 39 votes in opposition were cast by Republicans. GOP Sen. George Voinovich of Ohio was the only senator not to vote. Montana Sen. Max Baucus, the chairman of the Senate Finance Committee who has labored on health care for more than a year, flew in from his home state on a government plane for the vote and was returning afterward to be with his ailing mother.

To finance the expanded coverage, Reid proposed higher taxes as well as cuts totaling hundreds of billions of dollars in projected Medicare payments. Hardest hit would be the private insurance Medicare plans, although providers such as home health agencies would also receive significantly less in future years than now estimated.

The bill raises payroll taxes on incomes over $200,000 for individuals and $250,000 for couples. Reid eased the impact of an earlier proposal to tax high-value insurance plans, which has emerged as one of the principal methods for restraining the growth in health costs.

The bill includes tax increases on insurance companies, medical device makers, patients electing to undergo cosmetic surgery and drugmakers.