Uploaded on Dec 21, 2009
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Washington (CNN) -- Democrats won a major victory in their push for health care reform early Monday morning as the Senate voted to end debate on a package of controversial revisions to a sweeping $871 billion bill.
The 60 to 40 party-line vote, cast shortly after 1 a.m., kept Senate Democrats on track to pass the bill on Christmas Eve. If it passes, the measure will then have to be merged with a roughly $1 trillion plan passed by House of Representatives in November. The Senate went into recess until noon Monday shortly after the vote.
The vote left President Obama on the cusp of claiming victory on his top domestic priority and enacting the biggest expansion of federal health care guarantees since the enactment of Medicare and Medicaid over four decades ago.
"Today, the Senate took another historic step toward our goal of delivering access to quality, affordable health care to all Americans," Senate Majority Leader Harry Reid, D-Nevada, said in a statement.
The vote was the first of three this week requiring Democrats to win the backing of 60 members -- enough to break a GOP filibuster. Final passage of the measure, in the contrast, will require a bare majority in the 100-member chamber.
"The die is cast. It's done," New York Democratic Sen. Chuck Schumer proclaimed after the vote.
Liberal Democrats are particularly upset with Reid's decision to abandon a government-run public health insurance option and an expansion of Medicare to Americans as young as age 55 -- ideas strongly opposed by Lieberman and other centrists.
Among other things, they have agreed to subsidize insurance for a family of four making up to roughly $88,000 annually, or 400 percent of the federal poverty level.
They have also agreed to create health insurance exchanges designed to make it easier for small businesses, the self-employed and the unemployed to pool resources and purchase less expensive coverage. Both the House plan the Senate bill would eventually limit total out-of-pocket expenses and prevent insurance companies from denying coverage for pre-existing conditions.
Insurers would also be barred from charging higher premiums based on a person's gender or medical history.
Medicaid would be significantly expanded under both proposals. The House bill would extend coverage to individuals earning up to 150 percent of the poverty line, or roughly $33,000 for a family of four; the Senate plan ensures coverage to those earning up to 133 percent of the poverty level, or just over $29,000 for a family of four.
The Senate bill also cuts Medicare by roughly $500 billion. It does not include a tax surcharge on the wealthy, however. It would instead impose a 40 percent tax on so-called "Cadillac" health plans valued at more than $8,500 for individuals and $23,000 for families.
The Senate bill would also hike Medicare payroll taxes on families making over $250,000; the House bill does not.
Another key sticking point: the dispute over a public option. The House plan includes a public option; the more conservative Senate plan would instead create new nonprofit private plans overseen by the federal government.
Individuals under both plans would be required to purchase coverage, but the House bill includes more stringent penalties for most of those who fail to comply. The House bill would impose a fine of up to 2.5 percent of an individual's income. The Senate plan would require individuals to purchase health insurance coverage or face a fine of up to $750 or 2 percent of his or her income -- whichever is greater.
Both versions include a hardship exemption for poorer Americans.
Abortion has also been a sticking point for both chambers. A late compromise with Catholic and other conservatives in the House led to the adoption of an amendment banning most abortion coverage from the public option.
It would also prohibit abortion coverage in private policies available in the exchange to people receiving federal subsidies.
Senate provisions, made more conservative than initially drafted in order to satisfy Sen. Nelson, would allow states to choose whether to ban abortion coverage in plans offered in the exchanges. Individuals purchasing plans through the exchanges would have to pay for abortion coverage out of their own funds.
Nelson told CNN's "State of the Union" on Sunday that he would withdraw his support if the final bill gets changed too much from the Senate version under consideration.
Among other things, Nelson had a provision added to the bill requiring the federal government to cover Nebraska's costs for expanded Medicaid coverage after 2016. No other state is currently slated to receive such a benefit.
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