The US Senate began voting Tuesday on amendments and counter-amendments to the healthcare reform bill, as senators battle to shape the final product.
Tuesday was a big day on Capitol Hill, with the full US Senate set to start voting on historic healthcare reform legislation.
At this early stage, the votes are to approve or strike down proposed legislative amendments. In coming days senators will have to grind through lots of these, as members of both parties line up to try and shape the final product.
And healthcare reform still has a long roller coaster ride to go – through the Senate, to a conference committee, and back again to both Senate and House – before it becomes law, or flies off track to defeat.
“There are rough times ahead,” predicted Henry Aaron, a senior fellow in health affairs at the Brookings Institution, as the Senate began its work.
Senate debate on Tuesday began at around 2:15 pm, and quickly formed along expected lines. Sen. Charles Grassley (R) of Iowa, ranking minority member on the Finance Committee, led off by complaining about the size and possible expense of the effort, layered on top of federal bailouts of banks and auto firms.
Sen. Richard Durbin (D) of Illinois, assistant majority leader, responded by calling the bill “monumental, historic”. He charged that some in the GOP were just trying to protect the profits of private insurers.
The first amendment to the bill was scheduled to come up for a vote as early as Tuesday afternoon. It is a bipartisan effort, sponsored by Sen. Barbara Mikulski (D) of Maryland and Sen. Olympia Snowe (R) of Maine, to increase insurance benefits for women through yearly screenings for breast cancer.
The second amendment, filed by Sen. John McCain (R) of Arizona, would strip from the bill $400 million in Medicare cuts to home health providers, hospitals, hospices, and private providers of Medicare Advantage plans.
Democrats were to respond with their own Medicare amendment, promising that basic benefits would not be touched, and highlighting other advantages for seniors in the bill.
That sort of partisan warfare by amendment is likely to continue through coming weeks, as the Senate continues work on the bill while majority leader Sen. Harry Reid (D) of Nevada tries to line up a filibuster-proof majority of 60 votes.
Senator Reid has even promised Senators they are going to have to work on weekends as he tries to meet his self-imposed deadline of passing a bill by Christmas.
Victory or defeat on this bill likely will involve the thinnest of margins – one vote or two, either way. A number of tough issues – abortion funding, a possible government-run insurance plan, taxes on high-cost private insurance plans – stand between Reid and that winning edge.
Yet even if healthcare reform passes the Senate, the bill won’t be final.
The House has already passed its version of the bill. If the Senate does the same, then the two chambers will have to set up a conference committee, consisting of senior members of the House and Senate. And this committee will have the power to mash the two bills together, throwing bits out here, adding bits there, to make them identical.
For a big bill such as healthcare reform, this could be the crucial stage. Meetings are supposed to be open, but lots of bargaining in conference committees goes on behind closed doors. Members aren’t supposed to add things that aren’t in either the House or Senate version of the bill in question, but it still happens.
“Conferences are marvelous . . . It’s absolutely dazzling what you can do,” former Sen. Alan Simpson (R) of Wyoming once said.
There are big ideological differences between the House and Senate over such things as the design of a government-run insurance plan, the so-called “public option”. The fight to reconcile the two bills could be as tough as the one now going on, on the Senate floor.
And what happens after the conference committee reaches agreement? Sen. Reid would have to search for his 60-vote majority all over again, as the Senate, and the House, approve or disapprove of the final version.
So all that arguing now going on in the Senate? It’s just the beginning.