The Senate took the first tangible step Thursday in what will likely be weeks of wrangling over health care, approving a measure by Sen. Barbara A. Mikulski designed to enhance insurance coverage of mammograms and other screening tests for women by making them free of charge.
Later, the Senate defeated a Republican effort that would have effectively killed the $848 billion health legislation. It rejected a motion by Arizona Sen. John McCain, the 2008 Republican presidential nominee, that would have stripped nearly $500 billion in Medicare savings that Democrats are counting on to finance their plan.
A largely party line vote of 61-39 on the Maryland Democrat's amendment, co-sponsored by Republican Sen. Olympia Snowe of Maine, added a politically popular provision to the broader Senate plan for overhauling the nation's health care system.
Mikulski said afterward that she would press to have her amendment included in a final health care compromise, which would be crafted some time early next year if the Senate approves the sweeping legislation it took up this week. The House version does not include a similar provision.
During floor debate, and in a prepared statement from her office, Mikulski sought to emphasize the benefits of the Democratic measure now being considered by the Senate over strong opposition from Republicans.
"This amendment makes sure that the insurance companies must cover the basic care that women need at no cost," she said. Mikulski called health care "a women's issue" and demanded "universal access" to "key preventive services" for women, including annual screenings for heart disease and diabetes.
Mikulski's amendment would allow the U.S. Health and Human Services Department to require a package of free tests for women, removing current co-payment requirements or other costs to patients.
Democratic leaders made the provision the first amendment to be voted upon during the current Senate health debate, a nod to the political popularity of the proposal.
A cost of $940 millionSen. Russ Feingold of Wisconsin, one of two Democrats to vote against the measure, said that the Senate health care debate had "gotten off on the wrong foot" by taking up a provision that "would add almost a billion dollars to our budget deficits over the next 10 years." The Congressional Budget Office has estimated that the Mikulski amendment would cost $940 million by 2019.
The Senate action on women's health was prompted, in large part, by the controversy over a new government advisory panel recommendation that most women don't need routine mammograms until they turn 50. Mikulski was among those who reacted sharply to the recommendation, saying that she was deeply troubled by the change and warning that it could reverse decades of progress in breast cancer screening.
Under a specific provision attached to Mikulski's amendment, the advisory panel's latest recommendations would be rolled back to earlier advice about breast cancer screening, mammography and prevention. Those counseled women to start regular breast cancer screenings in their 40s.
The additional provision was sponsored by Sen. David Vitter of Louisiana, one of three Republicans who voted in favor of Mikulski's amendment.
Mikulski: 'Get it straight'Most Republicans supported an alternate women's health proposal, sponsored by Republican Sen. Lisa Murkowski of Alaska, which was defeated. Her amendment would have prevented the government from relying on the recent advisory panel recommendation about mammograms but would also have restricted the HHS secretary's ability to use comparative cost data in requiring free health screenings, as well as adding anti-abortion language.
As senators prepared for a roll call on the amendments, Mikulski pleaded with her colleagues to "vote for Mikulski, don't vote for Murkowski, and please on this one, get it straight." A few minutes later, the friendly rivals chatted amiably at Mikulski's desk on the Senate floor, well aware of what the outcome would be before the votes were tallied.
On the key vote of the day, Senate Republicans fell well short of returning the legislation to committee with orders to remove between $400 billion and $500 billion in Medicare cuts - a move that would have put an end to the overhaul plan.
Among the proposed cuts in the Senate measure are $118 billion in taxpayer subsidies for Medicare Advantage, which private insurers use to provide millions of senior citizens with enhanced benefits, including eye and dental care, that aren't part of the government's standard Medicare package. Another $150 billion in Medicare reimbursement cuts to health care providers, including hospitals, and $23 billion that a future Medicare payment commission is expected to make would also have been stripped from the legislation by McCain.
The vote on the Republican motion was 42-58, with all but two Democratic senators - Jim Webb of Virginia and Ben Nelson of Nebraska - voting against and every Republican voting in favor. A total of 60 votes was needed for approval.