WASHINGTON, D.C. - Invoking the name of Edward M. Kennedy, Democrats united Saturday night to push historic health care legislation past a key Senate hurdle over the opposition of Republicans eager to inflict a punishing defeat on President Barack Obama. There was not a vote to spare.
At a 10-year cost approaching $1 trillion, the measure is designed to extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny benefits and curtail the growth of spending on medical care nationally.
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.
Republican Sen. George Voinovich of Ohio missed the vote.
At a 10-year cost approaching $1 trillion, the measure is designed to extend coverage to roughly 31 million who lack it, crack down on insurance company practices that deny benefits and curtail the growth of spending on medical care nationally.
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.
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.
In hours of debate before the Saturday evening vote, a few Republicans piled copies of the 2,074-page bill on their desks while others criticized it as a government takeover of health care and worse.
"Move over, Bernie Madoff. Tip your hat to a trillion-dollar scam," said Sen. Kit Bond, R-Mo., likening the bill's supporters to the imprisoned investor who fleeced millions.
Sen. Judd Gregg, R-N.H., said Reid had delayed implementation of many of the bill's key provisions and made it look less costly as a result. He put the true price tag at $2.5 trillion over a decade once implemented.
"Senators who support this bill have a lot of explaining to do," said the Republican leader, Sen. Mitch McConnell of Kentucky. "Americans know that a vote to proceed on this bill is a vote for higher premiums, higher taxes and massive cuts to Medicare. That's a pretty hard thing to justify supporting."
Health care figured prominently in Obama's campaign for the White House last year, and is likely to do so again in next fall's midterm elections.
Among the most controversial is a requirement for the government to sell insurance in competition with private industry, unless individual states opt out.
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.
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.
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