The White House and its Senate allies defended a final push for historic healthcare legislation Sunday as outflanked Republicans pledged a fight to the end. A dead-of-night vote neared in a frenzy one GOP lawmaker said lacked "legislative sanity."
Republican Sen. John McCain, President Barack Obama's opponent in last year's election, said there was probably nothing to keep Democrats from passing the bill by Christmas Eve.
Still, he said, the GOP would not relent in the battle for public opinion.
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"We'll fight the good fight. We will fight until the last vote," said McCain, R-Ariz. He said the political climate under Obama has become more partisan than ever.
To keep the process moving under Senate rules, Democrats will need to show 60 votes — now secured, with the locked-in support of Nebraska Sen. Ben Nelson — in a series of votes.
The next one is set for 1 a.m. Monday.
"I think the American people are entitled to a vote," said David Axelrod, a senior adviser to President Barack Obama, as the Senate bill moved toward passage on Christmas Eve.
At its core, the legislation would create a new insurance exchange where consumers could shop for affordable coverage that complies with new federal guidelines. Most Americans would be required to purchase insurance, with subsidies available to help defray the cost. New protections would be offered to ensure people don't lose coverage because of health problems.
Yet major differences between the Senate version and the bill the House already passed, ranging from abortion restrictions to the new taxes that would help pay for the legislation. The White House refused to weigh in on that, focusing on the landmark action in the Senate.
Signs of difficult House-Senate negotiations ahead were already becoming apparent.
The House must stick close to the Senate's version of healthcare reform or risk losing the 60-vote coalition needed to overcome Republican opposition in the Senate, said Kent Conrad, D-N.D., the chairman of the Senate Budget Committee said Sunday.
To get Nelson's deciding vote, Senate Majority Leader Harry Reid, D-Nev., agreed to a series of concessions on abortion and other issues. McCain said Obama and Democratic lawmakers chose a partisan path that left them "having to purchase the last vote or two."
Democrats shot back that the healthcare debate has unfolded, exhaustively, for months.
The Senate bill has not drawn support from a single Republican.
"This bill is a legislative train wreck of historic proportions," the Republican leader, Sen. Mitch McConnell of Kentucky, said at a news conference. He pointed to cuts to Medicare that the Congressional Budget Office said totaled more than $470 billion over a decade, with reductions in planned payments to home healthcare agencies and hospices. He also said the bill includes "massive tax increases" at a time of double-digit unemployment.
One GOP lawmaker who had been in talks with the White House, Sen. Olympia Snowe of Maine, said the bill was being pushed through without a chance for meaningful debate or change.
She said the "beat the clock" approach "is really overruling legislative sanity."
Axelrod defended the bill against criticism that Obama had given up too much ground and angered core supporters from his own party in an effort to get a deal done this year. He said the bill offers more choices and security for Americans and savings for the government.
"There is no major piece of legislation that's ever been passed in this country that doesn't include compromise," Axelrod said. "That's the legislative process. But the question is, in the main, does it achieve what we want it to achieve? It's not perfect."
Vice President Joe Biden wrote in The New York Times Sunday that senators should support the bill because "it represents the culmination of a struggle begun by Theodore Roosevelt nearly a century ago" to improve health care.
"I would vote yes for this bill certain that it includes the fundamental, essential change that opponents of reform have resisted for generations," he wrote.
Senators were set to resume debate Sunday afternoon.
The deal to get Nelson's vote was built around the issue of abortion.
The compromise tries to maintain a strict separation between taxpayer funds and private premiums that would pay for abortion coverage. It would also allow states to restrict coverage for abortion in new insurance marketplaces.
No health plan would be required to offer coverage for the procedure. In plans that do cover abortion, beneficiaries would have to pay for it separately, and those funds would have to be kept in a separate account from taxpayer money.
Moreover, individual states would be able to prohibit abortion coverage in plans offered through the exchange, but after passing specific legislation to that effect. The only exceptions would be those allowed under current federal law.
Obama welcomed the breakthrough on health care legislation on Saturday, saying in a statement at the White House, "After a nearly century-long struggle, we are on the cusp of making health care reform a reality in the United States of America."
The Congressional Budget Office said the Senate bill would extend coverage to more than 30 million Americans who lack it. It also imposes new regulations to curb abuses of the insurance industry, and the president noted one last-minute addition would impose penalties on companies that "arbitrarily jack up prices" in advance of the legislation taking effect.
CBO analysts also said the legislation would cut federal deficits by $132 billion over 10 years and possibly much more in the subsequent decade.
In a concession to Nelson and other moderates, the bill lacks a government-run insurance option of the type that House Democrats inserted into theirs. In a final defeat for liberals, a proposed Medicare expansion was also jettisoned in the past several days as Reid and the White House maneuvered for 60 votes.
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