Senate action sends healthcare issue back to House for another vote

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The Senate completed its work on a package of amendments Thursday, forcing the House to vote once again on healthcare later in the day. By a 56-43 vote, the Senate approved a reconciliation bill that amended the healthcare insurance overhaul bill it passed Christmas Eve. The vote was largely along party lines, as befits the entire healthcare debate, a fiery, partisan divide that has monopolized Washington for more than a year. Three Democrats voted ‘no’ and one Republican was absent. Among the Democrats voting no was was Blanche Lincoln of Arkansas, who faces a tough reelection campaign. Republicans continued their opposition to the amendments through the overnight session that began Wednesday. Though they failed to derail the reconciliation bill, they succeeded in winning two points of order, which required the House to vote again. The House vote will be the last stop on a legislative journey that gave Americans a highly publicized look at how laws are made. Polls show that the overwhelming majority of Americans said they disliked the process, which became heavily politicized as Democrats and Republicans sparred over President Obama’s top domestic priority. The House, which had passed its own version of healthcare last fall, passed the Senate version on Sunday. Obama signed that bill into law on Tuesday.

But the House also passed a package of amendments designed to make the program more palatable to its members. The 153-page package of amendments is a small fraction of the gargantuan healthcare legislation that the House approved over the weekend. But it makes several major changes to the main healthcare bill, including expanding subsidies that the federal government will provide to low- and moderate-income Americans starting in 2014 to help them buy health insurance. The package also scales back a new 40% excise tax on high-end “Cadillac” health plans and delays its implementation until 2018. It imposes a new tax on couples making more than $250,000 annually, who will pay a 3.8% Medicare tax on capital gains and other investment income for the first time. The bill boosts federal aid to states to help them expand their Medicaid programs, replacing a provision in the main healthcare bill that singled out Nebraska for special assistance. And it would gradually close the gap in Medicare drug coverage known as the “doughnut hole,” phasing it out completely by 2020. Together, the healthcare legislation approved over the weekend and the reconciliation package approved Thursday are expected to cover an additional 32 million people by 2019, boosting the percentage of non-elderly Americans with insurance from 83% to 94%, according to estimates by the nonpartisan Congressional Budget Office. The Senate, where Democrats recently lost their supermajority, took up the House-approved amendments as a reconciliation measure, meaning that a simple majority was all that was needed for passage. Even though the outcome was assured, Republicans continued to battle, offering amendments and even a bill to repeal the healthcare law that Obama signed. All efforts failed in party-line votes, but Republicans have vowed to make the issue the centerpiece of their campaigns in this midterm election year and in the presidential cycle of 2012. The last Senate snag was two points involving the portion of the bill dealing with educational financing. In addition to dealing with healthcare, the bill puts the government in charge of funding higher education loans instead of private banks. The language, which Republicans said violated Senate budget rules, was dropped from the House-approved amendments. The corrected bill was sent to the House, where leaders said it was not expected to cause any serious delays in plans to recess for the holidays before the weekend. “This is quite benign,” Speaker Nancy Pelosi told reporters at a televised news conference on Thursday. “Of all the things they could have sent back this is probably the most benign.” Among the changes was killing the part that gave only Nebraska extra Medicaid funds, a provision designed to win the support of Sen. Ben Nelson, one of the last Democrats to decide to support the bill in December. But GOP efforts to strike other deals, including payments to a Connecticut hospital and Medicaid funds for Louisiana, were defeated. In all, Republicans offered more than 40 amendments, each handily defeated by Democrats. Part of the GOP strategy was to offer some amendments that could give them a political edge by creating ammunition to be used against Democrats in the fall.

By 57-42 vote, Democrats rejected an amendment by Sen. Tom Coburn (R-Okla.) barring federal purchases of Viagra and other erectile dysfunction drugs for incarcerated sex offenders. Coburn said it would save millions of dollars, while Sen. Max Baucus, (D-Mont.), called it “a crass political stunt.”

--Noam N. Levey, reporting from Washington --Michael Muskal, reporting from Los Angeles