News & Events

Health win in hand; hurdles ahead

By Lisa Wangsness, Globe Staff  |  December 25, 2009

WASHINGTON – Convening before sunrise for a historic Christmas Eve session, the Senate approved sweeping health care legislation yesterday in a party-line vote, moving Congress toward the brink of enacting a broad expansion of health coverage.

Before President Obama can achieve his top domestic policy goal, however, Democratic leaders must resolve stark differences between the Senate and House versions of the bill on matters such as abortion, taxes, penalties for employers that don’t provide coverage for workers, and whether to establish a government-run insurance plan.

But even with those contentious issues looming, Democrats rejoiced yesterday, celebrating passage of a bill after more than a year of grueling work.

The president, who waited until after the vote to leave for a holiday trip to Hawaii, told reporters that Congress was “fi nally poised to deliver on a promise’’ of a fairer and more affordable health care system.

“If passed, this will be the most important piece of social policy since the Social Security Act in the 1930s, and the most important reform of our health care system since Medicare passed in the 1960s,’’ he said after the 60-to-39 vote.

The Senate proposal, which like the House bill is modeled on the pioneering law Massachusetts adopted in 2006, would extend health insurance to some 31 million people, primarily by expanding the Medicaid program for the poor and by offering premium subsidies to those without affordable employer-sponsored insurance.

It would require Americans to have insurance while prohibiting insurers from denying coverage or charging higher rates because of illness or gender.

To help people compare prices and shop for insurance more easily, the bill would establish new government-sponsored marketplaces, or “exchanges,’’ much like the Massachusetts Health Insurance Connector, and the government would provide subsidies to people with low and moderate incomes.

According to the nonpartisan Congressional Budget Office, the roughly $900 billion cost over 10 years would be more than offset by higher Medicare payroll taxes on the wealthy; levies on expensive insurance policies; and Medicare spending cuts.

But Republicans say the bill would create a costly new government program, raise the deficit over the long term, burden businesses, encroach upon individual liberty, hurt care for the elderly, and ruin Medicare providers.

Minority leader Mitch McConnell of Kentucky said yesterday that, although they were outnumbered, Republicans were leaving “happy and upbeat,’’ and that Democrats would face wrath at home over the holidays and beyond.

“The public’s on our side,’’ he said, “and the fight’s not over.’’

Indeed, with polls showing tepid support for the federal health care legislation, industry groups are already lining up to defeat or weaken the bill. Hospitals – which previously reached a deal to accept $155 billion in lower payments over the next 10 years – say they should be on the hook for less because fewer Americans will be newly insured than originally envisioned. The US Chamber of Commerce and an influential small business group oppose the bill.

And even though insurers successfully fought to keep a government-run insurance plan out of the Senate version, they are now attacking other elements they say will drive up premiums, including a requirement that insurance companies spend 80 to 85 percent of their premium dollars on patient care.

The potential implications for Massachusetts are not clear, partly because the state’s insurance system is built on a special agreement with the federal government that will be renegotiated in 2011. But aides to Senator John F. Kerry said the state would benefit from $500 million in additional Medicaid money Kerry helped secure for the state in the Senate measure, and from new money for subsidies.

It was still dark yesterday when senators wearing Christmas ties and overcoats rushed into the Capitol for the 7 a.m. vote. With Vice President Joe Biden presiding in his role as Senate president, they cast votes from their desks, standing as their names were called.

Several weeks of detailed negotiations, late-night haggling, and voting at all hours of the night had clearly worn everyone down. Majority leader Harry Reid accidentally started to vote “no’’ before quickly correcting himself, with a sheepish shrug, as the chamber burst into laughter.

Tributes to Edward M. Kennedy, who died of brain cancer in August and who had called health care “the cause of my life,’’ abounded yesterday, most poignantly when the clerk called the name of Senator Robert C. Byrd, a 92-year-old West Virginia Democrat who is in frail health.

“Mr. President!’’ he shouted from his wheelchair, raising a trembling arm to point skyward and startling the chamber into silence. “This is for my friend Ted Kennedy! Aye!’’

In the first row of the gallery, Victoria Reggie Kennedy, the Massachusetts senator’s widow, wiped tears from her eyes. Later, in the Senate reception room, she embraced Senator Paul Kirk, who as Kennedy’s temporary replacement voted in his place yesterday. “Thank you,’’ she said.

Kirk later called it the proudest moment of his public life. “He’s having a merry Christmas in heaven,’’ he said of his friend.

The Senate has not voted on Christmas Eve since 1895, when it considered a motion to kill a bill to let former Confederate soldiers enter the Army, according to the Senate historian, Donald A. Ritchie. It has not held such a long continuous session – 25 days – since 1917, when senators opposed to US involvement in World War I filibustered a proposal to allow the arming of US merchant ships.

But Democrats insisted on passing the health bill before the Christmas break, and they did not finish wrangling all 60 votes required to overcome GOP filibusters until Saturday. Republicans then insisted on using nearly all the hours of debate that Senate rules allowed; ultimately they relented and allowed the last vote to occur about 12 hours early, so they could get home and join their families for holiday celebrations.

House and Senate leaders would like to pass final legislation by the State of the Union address in late January or early February, but they have refused to commit to a deadline.

The House and Senate conference committee that will craft a compromise bill will have to settle a fight over a Senate proposal to levy a 40 percent tax on insurance plans that cost more than $23,000 a year. Unions are particularly opposed because in many cases their workers have given up wages to keep comprehensive insurance policies.

Then there is the question of how to apply a longstanding policy prohibiting federal funding of abortions, except in cases of rape, incest, or danger to the mother’s life. The House bill forbids insurance plans from covering elective abortions if they accept premium subsidies for low- and moderate-income people.

The Senate would require women who receive government subsidies and who choose plans that cover abortion to write two premium checks each month – one for the overall premium and a second for the portion of the premium that covers abortion.

Antiabortion groups have harshly attacked the Senate compromise, calling it an “accounting gimmick’’ that would allow for indirect public financing of elective abortions. Abortion rights advocates say the bill would effectively bar abortion coverage from the exchange, where the vast majority of participants would receive subsidies.

Senator Olympia Snowe, Republican of Maine, the only member of the GOP who worked with Democrats through the fall on the health care legislation, lamented yesterday that she could not support the bill. She said lawmakers did not yet have analyses of exactly how the bill would affect premium rates for individuals and small businesses in different states.

Kerry downplayed the difficulty ahead. “We’re so close, and everybody understands what we have to find is a product that works,’’ he said.