WASHINGTON — The Senate Tuesday morning voted to approve a Democratic-authored package of compromises and cut off another Republican effort to engage in extended debate, inching the historic health care plan closer to final passage later this week.
The Senate first voted 60 to 39 — no Republicans were in the majority — on a plan that includes strict standards on federal abortion funding and creation of a federally-supervised series of national health care plans that would compete with private firms.
The second vote, 60 to 39, formally allows the Senate to move forward with the entire $871 billion health care bill. The early morning votes, completed at 8:12 a.m., were scheduled so senators could take a final vote on the bill before Christmas; that vote is now planned for Thursday night, Christmas eve.
Republicans have one more shot at continuing the debate, and a vote to cut off that effort is scheduled Wednesday afternoon. If Democrats again muster 60 votes, the minimum needed to limit the talking, the schedule remains intact. If the Senate passes the bill, as expected, conferees, or negotiators, from both houses of Congress will begin trying to reconcile differences between the Senate measure and one passed last month by the House of Representatives.
A key threat to eventual passage is the public's view of the legislation, said Paul Ginsburg, president of the Center for Studying Health System Change, a nonpartisan Washington research group.
It could take several weeks for the conference to produce a bill, and "that's a long time for public opinion to shift," he said, and its success, particularly in an election year, will depend on "how this plays out with the public over the next few months."
Signs of what could happen next are mixed.
"There's pretty broad agreement on a lot," said Elizabeth Carpenter, a health policy analyst at the New America Foundation, a center-left Washington research group.
Under both bills, insurers would be barred from rejecting anyone because of pre-existing conditions. Gone, too, would be the practice in many states of charging women more than men, and insurers would be limited in how much they could increase rates on older people.
Consumers would be able to shop for coverage through exchanges, much as they now scan the Internet for the best airline fares. Most people would have to obtain a certain level of coverage, and pay penalties if they failed to do so. Both houses agree on financial help for people having trouble affording coverage: They both would provide aid to families earning up to about $88,000 per year.
What could derail the entire effort are areas in which Democratic leaders have struggled for months to find common ground: abortion, taxes and the public option.
Ultimately, Democrats will write the final bill, because they control 60 Senate seats_ enough to cut off extended debate_ and 258 of the House's 435 seats. However, that means appealing to the approximately 52 moderate-to-conservative Blue Dogs in the House, as well as to the eight to 12 centrist Democrats in the Senate. That's likely to mean important concessions on the three big controversies.
Already, liberals' yen for a government-run insurance alternative and giving women more access to elective abortions faded when moderate senators balked.
Sen. Ben Nelson, D-Neb., who over the weekend provided the crucial 60th vote to cut off debate, explained a big reason he went along: "The Senate health-care bill is not perfect. Yet it doesn't include a public option or taxpayer funding of abortion I worked to exclude."
One of the public option's biggest boosters, Sen. Russell Feingold, D-Wis., realized that without the moderates, the entire health-care bill could be defeated.
"While the loss of the public option is bitter pill to swallow, on balance the bill still delivers meaningful reform, and the cost of inaction is simply too high," he said.
What all this means, said Barbara Kennelly, the president of the Committee to Preserve Social Security and Medicare, is that bill supporters need to be reminded, "This is truly an opportunity to begin health-care reform."
That desire to at least provide a foundation for future action is what worries skeptics.
Abortion rights supporters worry that the Senate bill doesn't go much further than the House version, which restricts federal funding to instances in which a woman's life is in danger or she's a victim of rape or incest. Abortion opponents think the Senate bill, which has somewhat less restrictive requirements, goes too far.
Taxpayer groups see too many taxes going up, since the House version imposes a 5.4 percent surcharge on individuals with adjusted gross incomes of more than $500,000 and couples making more than $1 million.
The Senate version includes a 40 percent excise tax on more expensive insurance policies and a 0.9 percentage point increase in the 1.45 percent Medicare tax for individuals with wages of more than $200,000 and couples earning more than $250,000.
"Democratic leaders put together a bill so heavy with tax hikes, Medicare cuts and government intrusion that in the end their biggest problem wasn't convincing Republicans to support it, it was convincing Democrats," scoffed Senate Republican leader Mitch McConnell, R-Ky.
However, Senate Majority Leader Harry Reid, D-Nev., was cheered Monday by a new CNN/Opinion Research Corp. poll, which found that support for the Democrats' health-care bill was up 6 percentage points over the last two weeks.
That poll, though, also showed Democrats have a long way to go, as 56 percent still oppose the bill, while 42 percent support it.
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