Senate Democrats win first health care overhaul votes

McClatchy NewspapersDecember 3, 2009 

WASHINGTON — The Senate voted 61-39 on Thursday to approve a plan that would make it easier for women to get medical screenings aimed at detecting a variety of diseases, such as cancer, heart disease and diabetes.

The first votes since debate began Monday on how to overhaul the nation's health care system were wins for Democrats. They championed the women's health measure and largely stuck together to defeat by 58-42 a bid by Republicans to undo more than $400 billion worth of Medicare cuts over 10 years.

The bill itself remained stalled, however. Though Democrats control 60 of the Senate's 100 seats, they've been unable to agree on abortion policy and how, or whether, to create a government-run alternative to private insurance.

The health care legislation, estimated to cost $848 billion over 10 years, would require nearly all Americans to buy health care coverage and would bar insurers from rejecting people because of pre-existing conditions.

Debate on the women's health plan — which is estimated to cost $940 million over 10 years — was an oasis of comity in the four-day-old health care debate. Most of the "no" votes came from Republicans, who were concerned about government interference in health care decisions.

They were outnumbered, however.

"We want to be able to save lives and we want to be able to save money," said Sen. Barbara Mikulski, D-Md., who sponsored the proposal with Sen. Olympia Snowe, R-Maine. "We do know early screening and detection does save lives and at the same time, it saves money."

The Medicare debate was more contentious.

"These Medicare cuts will impact seniors' access to quality care. This is a price that Americans should not be asked to pay," said Sen. John McCain, R-Ariz., who led the effort. All 40 Republicans voted for the amendment, joined by Democrats Ben Nelson of Nebraska and Jim Webb of Virginia.

Democrats countered that the cuts are meant to improve efficiency, not trim benefits. The Senate unanimously passed an amendment authored by Sen. Michael Bennet, D-Colo., that would assure that the spending cuts would help keep Medicare solvent and lower premiums.

One area in which most lawmakers agree, however, is that, as Mikulski put it, "for many insurance companies, simply being a woman is a pre-existing condition."

Women of child-bearing age now routinely pay more for health care because they're women. If they're pregnant, they can legally be denied coverage. Women tend to need more preventive care and therefore are subject to more co-payments and deductibles. In addition, single heads of households are often women, meaning they're responsible for the family's health care bills.

The bill would end the practice of basing rates on gender, which now is permitted in most states. The Mikulski plan, which won support from 56 Democrats, two independents and three Republicans, would make it easier to get preventive care. Two Democrats, Nelson and Russ Feingold of Wisconsin, opposed the amendment.

There'd be no co-payments for most screening services, and covered services would include those "supported by" the federal government's Health Resources and Services Administration, which works to provide greater access to health care, and the Centers for Disease Control and Prevention.

Covered services are expected to include annual mammograms for women older than 50, cervical cancer screenings, pregnancy and postpartum depression screenings, and annual women's health care screenings.

Such screenings, Mikulski said, are aimed at finding "silent killers that have a lethal effect on women," such as cardiovascular diseases.

Opposition came on two fronts. National Right to Life, an anti-abortion group, opposed the proposal, warning that because the government would have sweeping authority to define what services are covered, "that authority could be employed in the future to require all health plans to cover abortions."

Many also were concerned about the government getting heavily involved in health care decisions. Sen. Lisa Murkowski, R-Alaska, tried to dilute the government's power over such matters, but her effort failed 59-41.

She would've required insurers to consult with professional medical organizations to determine which prevention benefits should be included in health care plans. "Not bureaucrats in Washington," she said.

The Mikulski plan had strong support from women's groups, as well as from influential health care organizations, including the National Organization for Women and the American Cancer Society Cancer Action Network.

It also was aided by last month's controversy over mammograms. A government advisory task force composed of physicians and scientists said that women usually should begin routine mammograms after turning 50 rather than in their 40s. It contended that early screening can create false alarms and unnecessary biopsies.

The timing was horrendous for Democrats seeking health care legislation; many Republicans charged that such panels would become routine under the health care legislation and lead to rationed care, based on cost rather than medical need.

ON THE WEB

Mikulski women's health care amendment

Senate roll call vote on Mikulski amendment

Congressional Budget Office analysis of Senate Democrats' health care bill

Text of Senate Democratic health care bill

Congressional Budget Office analysis of House health bill

2009 Medicare/Social Security trustees' report

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McClatchy Newspapers 2009

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