President Barack Obama cheered a crucial healthcare vote in the Senate on Monday that put historic legislation well on its way to pre-Christmas passage and which sharpened already edgy partisan tensions.
The middle-of-the-night vote, which knocked away Republican attempts at procedural delays, required all 58 Democrats and the Senate's two independents to hold together. The next vote is expected around 7:20 a.m. Tuesday.
Obama called the vote "a big victory for the American people," and challenged critics who say it will increase, not reduce costs.
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"For all those who are continually carping about how this is somehow a big spending government bill, this cuts our deficit by $132 billion the first 10 years, and by over a trillion in the second," Obama said. "That argument that opponents are making against this bill does not hold water."
Majority Leader Harry Reid, D-Nev., said: "Never have we been so close to reforming America's broken insurance system."
The American Medical Association announced its support for the rejuvenated bill, the product of marathon negotiations that secured the votes of Sens. Joseph Lieberman, a Connecticut Independent, and Ben Nelson, a conservative Nebraska Democrat. The AMA's support came even though the bill doesn't address a top organization goal — a permanent fix to a flawed Medicare reimbursement formula that would cause payments to doctors to drop by 21 percent in January.
Still, Reid did make some last-minute changes to court doctors' support.
A proposed fee on physicians to enroll in Medicare, originally set at $300 annually, was dropped in a final package of amendments, and payment cuts to specialty physicians to pay for bonuses to primary care doctors in underserved areas were also eliminated, the AMA's president-elect, Dr. Cecil B. Wilson, said.
"America has the best healthcare in the world — if you can get it," Wilson said. "For far too many people access to care is out of reach because they lack insurance. This is not acceptable to physicians."
With final passage on track, Republicans ramped up their criticism, denouncing the last-minute deals and concessions needed to get the 60 votes needed to overcome GOP tactics.
"I am tired of the Congress thumbing their nose and flipping a bird to the American people," Republican National Committee Chairman Michael Steele said in a conference call with reporters.
Reid promptly criticized Steele for saying "something so obscene" and "so crass and such a terrible example for the youth."
Sen. John McCain, R-Ariz., criticized the side deals needed to win key votes, calling them "Bernie Madoff gimmicks."
Still, the vote represented a major victory for Democrats and Obama, who's now clearly in reach of passing legislation extending health coverage to nearly all Americans, a goal that's eluded a succession of past presidents. The legislation would make health insurance mandatory for the first time for nearly everyone, provide subsidies to help lower-income people buy it, and induce employers to provide it with tax breaks for small businesses and penalties for larger ones.
Two more procedural votes await the Senate, each requiring 60 votes, the first of these set for Tuesday morning. Final passage of the bill requires a simple majority, and that vote could come as late as 7 p.m. on Thursday, Christmas Eve.
The Senate measure still must be harmonized with the healthcare bill passed by the House in November before final legislation can be sent to Obama's desk.
There are significant differences between the two measures, including stricter abortion language in the House bill, a new government-run insurance plan in the House bill that's missing from the Senate version, and a tax on high-value insurance plans embraced by the Senate but strongly opposed by many House Democrats.
After Monday's vote a number of Senate Democrats warned that the legislation could not change much and expect to maintain support from 60 senators.
Republicans are determined to give Democrats no help, eager to deny Obama a political victory and speculating openly that the healthcare issue will hurt Democrats in the 2010 midterm elections.
At their core the bills passed by the House and pending in the Senate are similar. Each costs around $1 trillion over 10 years and is paid for by a combination of tax and fee increases and cuts in projected Medicare spending. Each sets up new insurance marketplaces called exchanges where uninsured or self-employed people and small businesses can compare prices and plans designed to meet some basic requirements. Unpopular insurance practices such as denying people coverage based on pre-existing conditions would be banned, and young adults could retain coverage longer under their parents' insurance plans — through age 25 in the Senate bill and through age 26 in the House version.
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