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Congress Approves Final Health Care Package

First Posted: 05/24/10 06:12 AM ET   Updated: 05/25/11 04:55 PM ET

UPDATE 3/25 9:47 PM
It wasn't easy and it wasn't pretty, but the congressional debate over comprehensive health care reform ended Thursday night with Democrats routing a united Republican opposition.

By a vote of 220-207, Democrats passed a package of amendments to the reform bill that President Obama signed into law on March 23. The reconciliation package reduces the bite of the excise tax on "Cadillac" insurance benefits and raises revenue by increasing Medicare taxes on the wealthy. It does not include a public insurance option, though backers of the plan said they will work to see it implemented in follow-up legislation. The bill now heads to President Obama for his signature.

In the short term, Congress will make more fixes to the bill now that it has become law. Because the Massachusetts special election of Republican Scott Brown cut the regular process short and detoured Democrats into reconciliation, the party was limited in changes that it could make.

"One, we're going to examine the things we would like to see corrected, but we're going to prioritize it in terms of what is most easily accomplishable," Judiciary Committee Chairman John Conyers (D-Mich.) told HuffPost after the vote.

Due to loose legislative language, Obama's signature promise -- that children will be able to obtain insurance regardless of preexisting conditions, immediately upon signing -- is lacking and will need to fixed, along with other loopholes that will be fixed by Congress.

Progressive Democrats will continue to push, meanwhile, for substantial advances. "It is a beginning," Rep. Keith Ellison (D-Minn.) told HuffPost. "Remember, there was a 1957 Civil Rights Act; then there was a 1960 Civil Rights Act; then a 1964 Civil Rights Act' then a 1965 Voting Rights Act; and there have been subsequent voting and civil rights bills."

Thursday's victory was a step forward in the health care fight, he said, but far from the last step. "I'm solidly in favor of the public option. I'm a single-payer backer and I think that's what we're ultimately going to end up with. I hope it doesn't take too long," he said. "You know, if there was no '57 act, maybe there would never have been a '64 act. So this is an important prelude. It's a good day."

Advocates of the bill will also focus on its implementation. "We have closed the book on decades of struggle to make good, affordable health care a right -- and not exclusively a privilege -- for America's families," said Richard Kirsch of the coalition Health Care for America Now. "With the closing of this volume, we also prepare to open another. We will need to continue to hold lawmakers and big insurance accountable and make sure we implement reform in way that truly achieves good, affordable health care for all."

Conyers, a leading single-payer backer, said that the year-long debate had made some people start to give single-payer a real look. Indeed, the greatest and most cost-effective way that the health care bill expands coverage is based on expanding a single-payer system known as Medicaid. The expansion of Medicare, which was briefly considered before being discarded by Sen. Joe Lieberman (I-Conn.), was also widely popular and based on a single-payer system.

"There were people who have never endorsed single payer and started saying, 'Hey, Conyers, there's more to this single-payer that a lot of people, including myself, appreciated until now,'" he said.

UPDATE 3/25 2:23PM

Senate Democrats passed the final health care reconciliation package on Thursday afternoon by a vote of 56-43, moving the measure to the House where it will face a last vote before heading to the White House. A vote is expected later Thursday in the lower chamber.

Three Democratic senators voted against the legislation, Blanche Lincoln and Mark Pryor of Arkansas and Ben Nelson of Nebraska.

An ailing Sen. Johnny Isakson (R-Ga.) missed the vote.

The Senate action today comes after Beltway pundits said for months that using reconciliation to finish the health care bill was simply impossible. To have been proven wrong so quickly seems to undermine the ability of the punditocracy to continue to play referee to American politics.

MSNBC's Chris Matthews flat-out declared it was not possible, based on his former time as a staffer on Capitol Hill. "They cannot get passed the filibuster rule," Matthews declared, asking a member of Congress who was floating the idea of reconciliation what he was talking about. "What do you mean reconciliation? You can't create a program through reconciliation... This is Netroots talk."

On the night in January that Scott Brown won the Massachusetts special election, the network's Lawrence O'Donnell went on the air to shoot down speculation that reconciliation might be used.

"What everyone has to remember about reconciliation -- there'll be a huge demand for it -- reconciliation requires 60 votes every single day on several procedural parliamentary motions that come up during a reconciliation bill, and if you don't win those parliamentary motions your bill gets ripped apart. And even then, within the rules of reconciliation, it's impossible to do some of the elements of health care reform because of the rules of reconciliation," said O'Donnell. "So I'm sitting here saying I don't see how you go forward from here. I don't know what the play is."

Matthews' and O'Donnell's pessimistic analysis created a political hurdle for Democrats in Congress, but leadership concluded reconciliation was the only path forward. To O'Donnell's credit, he didn't express absolute certainty, as Matthews did.

"Surprise me again," O'Donnell said to Pelosi and Reid. [UPDATE: O'Donnell, whose analysis of the reconciliation process throughout the debate was generally spot-on, writes in to say that the discussion was whether the entire health care reform package could be passed through reconciliation, the answer to which was 'no.' He was not contemplating, he said, whether reconciliation could be used merely for the package of changes that fixed the already-passed Senate bill.]

WATCH:

Senate Democratic staff cut a clip of Reid speaking just before the historic vote. Missing from this video is Reid accidentally voting no -- just as he did in December -- before dropping his head in embarrassment and correcting his vote to an aye.

WATCH:

UPDATE 3/25 2:45 AM

The parliamentarian discovered Byrd Rule violations in the legislation, leading Reid to adjourn until 9:45 a.m.

UPDATE 3/25 12:35 AM

Senate Majority Leader Harry Reid and the Democratic caucus mowed through the first tranche of 23 amendments that Republicans offered to the health care reconciliation package, winning each vote a fair margin Wednesday night and into Thursday morning.

Reid (D-Nev.) is now pushing forward into the second tranche, dismissing a suggestion from Senate Minority Leader Mitch McConnell (R-Ky.) that the chamber adjourn and regroup at a "reasonable time in the morning after everybody's had a chance to get some sleep."

Sen. Roland Burris (D-Ill.), had already availed himself of that chance, and appeared to be catching a few Zs with his elbow on his desk and his face buried in his hand. Senators across the chamber rubbed their bleary eyes.

But Reid, after running through more than a year of the health care obstacle course, said he had no intention of resting with the finish line tantalizingly in sight. "I want to finish this legislation. And I want to do that as quickly as we can. And so I would ask that we just proceed. I hope that there aren't that many more amendments, but we're here for the duration," said Reid. "I'm an old marathoner and getting older every day."

With no deal on the table, the Senate returned to considering the GOP amendments. Cue Sen. Jim Bunning (R-Ky.), who rose to amend the health care reconciliation package to allow wealthy people to opt out of Medicare.

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