Without a single Republican vote, the United States Senate passed a sweeping health care reform bill in a landslide, shortly after 7:00 in the morning on Christmas Eve. After months of intense back and forth, and more than three weeks of continuous floor debate, the bill moved through the Senate by a gaping 60-39 margin.
The House of Representatives previously passed a much stronger version of reform with a tighter 220-215 margin. The two versions will now be merged in conference committee negotiations, with the House pushing for more generous subsidies for those required to buy insurance and the Senate attempting to hold the line. The cross-Capitol negotiations will not involve the Republican Party.
It appears that the bill might be delayed before it moves into conference committee negotiations. Roll Call reports that Senate Republicans "continued to make life difficult" for Majority Leader Harry Reid (D-Nev.), by blocking efforts to name conferees to negotiate a final version of the health care bill. Roll Call reports:
After Thursday's early morning vote to pass the health care bill, Reid hoped to name his conferees to the House-Senate conference on the bill. But Democrats dropped the plan after it became clear Republicans would object, a senior Democratic leadership aide said.
The Senate debate of the health care bill is the second-longest in history, according to Politico. The health care bill was debated for 25 consecutive days and is surpassed by just one more debate: the one that preceded the U.S. decision to enter World War I.
Sen. Ben Nelson (D-Neb.), who cast the deciding 60th vote to break a GOP filibuster, said after the vote that the conference report could not include "material changes" if it wanted to keep his support.
Rep. John Dingell (D-Mich.), whose name is upon the House bill, was on hand for the Senate vote Thursday. He predicted that the House would eventually fall in line. "I think that the House will come together behind this bill," he said. Asked what the House would need, he declined to say. "In a poker game, I never show my cards."
The senators voted, in ceremonial style, seated behind their desks. A few moments of levity punctuated the historic event. When the clerk called the name of Sen. Harry Reid (D-Nev.), the majority leader, rose to etch his name in history. "No," said Reid. He quickly caught his mistake.
"Ah, yes. Aye," he corrected as the Senate well and galleries erupted in laughter. Reid buried his head in his arms, with an apparent mixture of both mock and real embarrassment. By way of explanation, he later said, "I was restless last night as I was trying to figure how I could show some bipartisanship."
The 92-year-old Sen. Robert Byrd (D-W.Va.), a former majority leader himself, seemed more prepared when history knocked. "Mr. President," Byrd said, raising his right hand and pointing to the domed ceiling, "This is for my friend Ted Kennedy. Aye!"
Kennedy's replacement in the Senate, Paul Kirk Jr., a longtime friend of the late liberal lion, appeared to tear up as he voted aye, blinking and gazing about the Senate chamber as Sen. Ben Cardin (D-Md.) comforted him with an arm rub.
Two senators filed in late for the vote. Sen. Orrin Hatch (R-Utah) walked in just as his name was called and had to be alerted by Sen. John Thune (R-S.D.) that he was up. He casually gave the bill the thumbs down.
On the other end of the spectrum, Sen. Bernie Sanders (I-Vt.) wasn't in the chamber when his name was called. Bursting through the door at 7:14, he gave a thumbs up to the Senate desk as he briskly passed by, eliciting mock applause from his colleagues. "Have something else this morning?" teased a Democratic senator as he found his seat. (It was either Tom Carper or Ted Kaufman, both of Delaware; it was hard to tell from the gallery which one said it.)
The bill provides billions in subsidies for low and middle class Americans to purchase private insurance. All Americans would be required to be insured unless they can demonstrate that doing so would be unaffordable. The GOP, along with some constitutional scholars, argues that such a mandate is unconstitutional. Other scholars disagree and the matter is sure to be litigated.
The bill also includes expansive new insurance industry regulations, though they are phased in over the next several years. Insurers, beginning in 2014, would not be allowed to deny customers due to preexisting conditions and would not be allowed to cap annual or lifetime benefits.
Karen Ignagni, President and CEO of America's Health Insurance Plans (AHIP), the industry's lobby group, put out a statement critical of the bill, although insurers will be on the receiving end of trillions more dollars as a result of reform. Insurers also succeeded in stripping a public insurance option from the Senante bill that would have competed with private insurance to keep the plans honest. In the absence of the public option, state insurance commissioners will be charged with keeping insurers in line -- a task they have so far shown themselves unable to accomplish.
"[S]pecific provisions in this legislation will increase, rather than decrease, health care costs; reduce coverage options; and disrupt existing coverage for families, seniors and small businesses -- particularly between now and when the legislation is fully implemented in 2014," said Ignagni. "These issues can and should be addressed if health care reform is going to fulfill the promise of providing all Americans with guaranteed access to affordable, portable health care coverage."
Backers of reform hope that over time, the law will be strengthened, the subsidies increased, a public option put in place. "The work goes on. The cause endures," Reid said from the Senate well, quoting a famous speech by Ted Kennedy.
"With passage by the Senate, the nation has moved one big step closer to comprehensive health care reform," said Richard Kirsch, National Campaign Manager for Health Care for America Now, pro-reform group. "Health Care for America Now will work to get the strongest bill to the President's desk, one that provides good, affordable coverage to all and holds insurance companies accountable."
The White House was also pleased. "This is a great moment for the country that within weeks now Americans are going to realize they can be protected from abusive insurance company practices," White House spokeswoman Linda Douglass told HuffPost. "They will always have the security of knowing they can find affordable health insurance. And this is the culmination of 70 years of effort to try to create a secure foundation for Americans."
The bill has been so weakened throughout the process that loud calls had come from progressive quarters to kill the bill and start fresh using a reconciliation process, which would require a simple majority rather than 60. They were unable to pressure any progressive senators to vote no, however. Sen. Russ Feingold (D-Wisc.) was a prime target, but he cited home-state benefits in justifying his support.
"The Senate health care bill is far from perfect. I am deeply disappointed it does not include a public option to help keep down costs and I also don't like the deal making that secured votes with unjustifiable provisions. I will work to improve the bill, including restoring the public option, when the final version is drafted," said Feingold.
The horse-trading to get to 60 votes sent a hundred million dollars to Nebraska and millions more to Louisiana and a handful of other states that were singled out for special treatment. Wisconsin got its share, said Feingold.
"[W]hile this bill could and should have been much stronger, it includes very important provisions for Wisconsin that I worked to include. The bill will bring more Medicare dollars to Wisconsin by improving the unfair reimbursement formula that has siphoned money away from the state for years, and by rewarding the high-quality, low-cost care practiced at places like Gundersen Lutheran and the Marshfield Clinic. Wisconsin taxpayers also win because we will see a boost in Medicaid funding, so our state isn't harshly penalized for its leadership in expanding coverage."
The GOP vowed to continue to fight the bill. If it can't block final passage, the party will campaign on a pledge to repeal it. "The battle is not over," said a tight-lipped Sen. Charles Grassley (R-Iowa), who took part in bipartisan negotiations over the summer that ultimately collapsed.
After those negotiations fell apart, when the Senate Finance Committee approved its version of the bill in October, Sen. Pat Roberts (R-Kan.) said he was "terribly concerned that we are riding hell-for-leather into a health care box canyon full of spending quicksand, cactus tax hikes, policy briar patches, complete with CMS regulatory scorpions, rattlesnakes and bad-news bears."
Shortly after Thursday's vote, HuffPost queried Roberts on the horse's whereabouts.
"You mean the one they rode hell-for-leather into the canyon? They have yet to find their way out," Roberts said. "And the strangest thing is that there's a lot of cactus in that canyon and they have chosen to sit on virtually every damn one of them."
(Cactus is no obstacle for Harry Reid, who said Wednesday that after the vote he planned to go home and "just sit back and watch my rabbits eat my cactus.")
Democrats seconded the horse theme on Thursday when Sen. Chuck Schumer (N.Y.) referred to three of his colleagues -- Sens. Chris Dodd (Conn.) Max Baucus (D-Mont.), and Reid -- as "the three horsemen" of reform.
"This is an amazing accomplishment," Schumer said. "It would be under ordinary times, it's even more amazing under extraordinary times...And the three horsemen of this bill are behind me."
Roberts said the horsemen would have some help finding their way out of the canyon.
"I fully expect for them to find their way out. We're sending some people in to help them out -- mostly health care providers and small hospitals. And they're forming up a posse and they're going to get them up. But the health care pick up has got an awful lot of barbed wire underneath it."
This posse registered with the federal lobbyist database?
"Oh, no. Oh, no. They're on their own. They're on their own," he said. Then he channeled Gunsmoke. "Actually, Matt, and Miss Kitty, and Doc, and Festus, all of 'em are still out there. They're gonna keep workin' at it."