Senate Democrats Win Key 60-40 Vote on Health Care

Washington — The Senate early Monday voted 60 to 40 to cut off extended debate on the Democratic-authored health care overhaul bill, the first major step toward passing the measure later this week.

The vote, which saw all 58 Democrats and two independents vote to end the latest debate while all 40 Republicans opposed the maneuver, ended at 1:19 a.m. and capped a day of debate that turned partisan and often angry.

“If the people who wrote this bill were proud of it, they wouldn’t be forcing this vote in the dead of night,” Senate Republican Leader Mitch McConnell, R-Ky., said as he made a final post-midnight plea to derail the $871 billion bill. “The final product is a mess _ and so is the process that’s brought us here to vote on a bill that the American people overwhelmingly oppose.”

Senate Majority Leader Harry Reid, D-Nevada, countered: “This is not about politics. It’s about people. It’s about life and death in America.”

The vote, the first of three planned this week aimed at cutting off different debates, found Democrats marching united and determined toward anticipated passage of historic health care legislation late Wednesday or Thursday. If that happens, the Senate bill will have to be reconciled with the version the House of Representatives passed last month.

Most of the talk on Capitol Hill Sunday centered on the difficult clashes ahead over abortion, taxes and the public option.

Resolving those differences will be up to a conference, or negotiating, committee, which is expected to be dominated by senior lawmakers from both Houses close to Senate Majority Leader Harry Reid, D-Nevada, and House Speaker Nancy Pelosi, D-Calif.

White House officials are expected to be close to the talks; Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius, Budget Director Peter Orszag and top health care adviser Nancy-Ann DeParle have all been frequent visitors to the Capitol in recent weeks to discuss strategy.

Many major points in both bills are roughly the same. Insurers would be barred from denying coverage because of pre-existing conditions. Nearly everyone would have to obtain coverage in four or five years. New exchanges, or marketplaces, would be created to help consumers shop for policies.

But there are sharp divisions over abortion, taxes and the public option.

Abortion has already come closest to making the legislation implode in both Houses.

Last minute deals with anti-abortion Democrats were needed to keep the bills alive. The Senate bill is moving forward largely because of a painstakingly negotiated weekend agreement with Nebraska Sen. Ben Nelson, the last Democratic holdout on the bill, giving his state substantial new Medicaid aid, and placing strict limits on abortion.

The House version bars federal funding of elective abortions except in cases of rape, incest or where the life of the woman is endangered.

The Senate bill also will ensure that no public funds will be used for abortion, except those now allowed, and require that every state provide an insurance plan option that does not cover abortion. Plans that offer abortion coverage would have to keep an account for private premium dollars and another for federal money, and consumers would have to pay separately for the coverage. The measure also provides each state the right to pass a law barring insurance coverage for abortion within state borders.

Neither side seemed satisfied. “I am disappointed that women’s access to full reproductive health care is again paying the price,” said Rep. Lois Capps, D-Calif., a leading House abortion rights supporter.

But anti-abortion lawmakers also were not pleased. Rep. Bart Stupak, D-Mich., who led the House fight to limit abortion funding, said the Senate bill was “a dramatic shift in federal policy that would allow the federal government to subsidize insurance policies with abortion coverage.”

Taxes also loom as a vexing issue. The Senate bill raises money by increasing the Medicare tax, now 1.45 percent, by 0.9 percentage points on individuals with wages of more than $200,000 and couples earning over $250,000. It also would impose a 40 percent excise tax on most high-end expensive insurance policies.

Many House Democrats, as well as some labor union officials, see the excise tax as a burden on the middle class, and prefer a 5.4 percent income tax surcharge, starting in 2011, on individuals with adjusted gross incomes of more than $500,000 and joint filers making more than $1 million.

What once seemed to be the biggest fight, though, the public option, may be cooling.

The House version would create a government-run plan to compete with the private sector, an idea the White House, Democratic leaders and liberals have all sought. And while that idea has strong Senate Democratic support, it lacks the backing of a handful of party moderates _ enough to deny Reid the 60 votes he would need to cut off extended debate.

As a result, the version now before the Senate would allow national, privately run plans, at least one of which must be nonprofit, to be supervised by the federal Office of Personnel Management.

Asked if she could “live without a public option” at a meeting with reporters last week, Pelosi said, “It depends on what else is in the bill.” After the Senate Saturday announced its compromise, Pelosi and House Majority Leader Steny Hoyer, D-Md., issued a joint statement that stayed away from endorsing or opposing anything specific.

“The Democratic Caucus is committed to middle class affordability, security for our seniors, responsibility to our children, and accountability for the insurance industry,” it said, adding, “”On that basis, we look forward to working with the Obama Administration, the Senate, and our Caucus to reconcile our bills and send final legislation to the President’s desk as soon as possible.”

Sympathetic senators also seemed ready to accept something less than the public option.

“I’m deeply disappointed the public option is not in the bill,” said Sen. Al Franken, D-Minn. But there were other features he liked, and said, “There is a huge victory for those of us interested in keeping costs down.”