Senate Democrats this morning passed a sweeping healthcare overhaul bill, setting the stage for reconciliation early next year with similarly historic legislation passed by the House last month.
The vote was 60-39. It came after months of bitter partisan warfare, culminating in a series of votes this week that thwarted a threatened Republican filibuster.
The bill, which is President Obama's top domestic priority, would extend insurance to about 30 million people who now lack it, expand the reach of Medicaid for the poor, and impose new rules on health insurance companies. It would cost about $871 billion over 10 years, but raise more than that in new taxes and fees and cuts in Medicare.
Democrats were triumphant but weary as they passed the bill and ended a long, eventful year of legislating under the Obama presidency. "This is a victory for the American people," Senate Majority Leader Harry Reid (D-Nev.) said after the vote. "This is a victory because we've affirmed that the ability to live a healthy life in our great country is a right and not merely a privilege for the select few.""
But Republicans, whose delaying tactics and demand for extended debate forced Democrats to postpone the Senate vote until Christmas Eve, vowed to keep fighting the bill as it heads into House-Senate negotiations that will craft the final bill.
"This fight is long from over," said Senate Republican Leader Mitch McConnell (R-Ky.). "My colleagues and I will work to stop this bill from becoming law."
Underscoring the drama of the vote, Vice President Joe Biden presided over the roll call from the chair. Senators cast their votes from their desks of the Senate floor, a custom reserved for the most momentous occasions. Only Sen. Jim Bunning (R-Ky.) was absent.
Watching from the public gallery were others soldiers in the long fight for the healthcare bill - senior aides to Obama; Rep. John Dingell (D-Mich.), dean of the House and lead sponsor of the House bill; and Victoria Kennedy, widow of the late Sen. Edward M. Kennedy (D-Mass.), the lifelong champion of healthcare reform who died earlier this year.
"This is for my friend Ted Kennedy," declared the ailing, 92-year-old Sen. Robert C. Byrd (D-W.Va.) before casting his vote.
Today's outcome had been almost certain since last weekend, when Senate leaders persuaded some holdouts such as Sens. Joe Lieberman (I-Conn.) and Ben Nelson (D-Neb.) to support the bill, giving Democrats the 60 votes needed to ward off the Republican filibuster.
But the path to passage was not easy. Many moderate Democrats only joined the effort after Senate Majority Leader Harry Reid (D-Nev.) dropped the most controversial part of the plan: a provision that would have created a government-run health insurer to compete with private companies, the so-called public option. The House bill contains such a provision.
The Senate bill would lead to the largest transformation of the country's healthcare system since the creation of Medicare in 1965. It would require all Americans to have health insurance, either through their jobs, through the government or through the private market, and it would penalize those who do not comply.
The bill would set up state insurance exchanges, where people could purchase health insurance, and provide federal subsidies to help low- and middle-income people afford the premiums. It would expand Medicaid to those who make 133% of the federal poverty level.
Critics say that the bill does little to contain the rising cost of insurance, arguing that people will be forced to purchase insurance at ever-increasing prices.
If it becomes law, the measure would also prohibit insurance companies from refusing to insure people with preexisting medical conditions and from canceling policyholders' coverage when they become ill. It would also restrict insurers from capping benefits for consumers annually or over their lifetimes.
As part of a compromise struck with antiabortion Democrats, the bill bars the use of federal subsidies to pay for abortion services, requiring recipients of the federal funds to pay the cost of abortion coverage out of their own pockets.
The nonpartisan Congressional Budget Office says the bill would cost $871 billion over 10 years and cut the federal deficit by $132 billion over that time. The bill is financed through a combination of Medicare cuts, increased payroll and excise taxes, and new fees on health insurers, medical device-makers and the pharmaceutical industry.