Senate passes historic healthcare reform legislation in 60-39 vote

The Senate approved sweeping healthcare reform legislation by the narrowest of partisan margins early Christmas Eve morning, placing President Barack Obama closer than ever to signing a longtime Democratic priority into law.

The 60-39 tally split directly along partisan lines, with Sen. Jim Bunning (R-Ky.) absent, underscoring not only the great divide between Democrats and Republicans but also the deftness with which Majority Leader Harry Reid (D-Nev.) at long last united his fractious conference by offering key compromises to centrists but keeping liberals in the fold.

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The Senate capped off a nearly monthlong floor debate with its near-record 25th consecutive day in session by holding a vote on Christmas Eve for the first time since debating the Vietnam War in 1963. The debate was marked by procedural gamesmanship and acrimonious partisan exchanges. Nevertheless, the outcome of Thursday’s vote, with Vice President Joe Biden presiding over the Senate, had been assured for days as Democrats put together 60 votes numerous times on procedural matters.

“Never before has the Senate found the resolve to make health insurance more affordable and health insurance companies more accountable until today,” Reid said after the vote. “This is a victory for the American people. Those fortunate enough to have health insurance will be able to keep theirs, and those who do not will be able to have health insurance.”

Reid assembled his fragile coalition in spite of middling public opinion polling about healthcare reform, entrenched opposition from the health insurance industry and corporate interests and his party being denied the spiritual leadership of the “Lion of the Senate,” Sen. Edward Kennedy (D-Mass.), who died in August of brain cancer and was absent from the Senate nearly all year. Kennedy's widow, Victoria Reggie Kennedy, was in the gallery for the vote early Thursday.

Perhaps most remarkably, Reid succeded in spite of his own troubled political fortunes at home. Like another central figure in the healthcare reform effort facing an uphill reelection battle next year, Sen. Chris Dodd (D-Conn.), Reid’s Senate career could be over before the bill’s major provisions take effect.

There is more intraparty friction on deck when Senate leaders work to meld their bill next month with the more liberal measure approved by the House. Disputes are already bubbling on hot-button issues such as abortion, whether to create a government-run public option insurance program as part of the bill and how to raise tax revenue to finance the new benefits the legislation would create.

The legislation had built-in advantages that counterbalanced those challenges, however, starting with a Democratic Conference that is exactly equal in size to the number of votes needed to beat back Republican filibusters: 60. Having a Democrat in the White House and Democrats controlling the House helped contribute to an atmosphere of inevitability at times during the process.

Key late-stage endorsements from influential groups such as the AARP, the American Medical Association and the American Hospital Association also allowed Democrats to counter Republican arguments that the legislation would devastate Medicare and the healthcare system.

Unity was not the sole province of Democrats, however, as Minority Leader Mitch McConnell (R-Ky.) kept his flock together throughout most of the year — with one notable exception — in opposition to a bill he often referred to as a “monstrosity” of government encroachment, high spending and big tax increases. Republicans were assisted, though not as strenuously as during President Bill Clinton’s failed attempt at healthcare reform, by business groups such as the U.S. Chamber of Commerce and the National Federation of Independent Business, which spoke out strongly against the bill.

“This fight isn’t over. In fact, this fight is far from over,” McConnell said before the Senate vote. “My colleagues and I will work to stop this bill from becoming law.”

In the end, Obama and Reid were denied the one Republican who appeared attainable: Sen. Olympia Snowe (Maine). The centrist voted for the healthcare bill approved by the Finance Committee in October and was in constant contact with the president, even within the last several days. Her influence is apparent in components of the legislation despite her vote in opposition — based, she explained, on her view that Democrats were moving too quickly to get the bill off the floor.

The road was long and difficult indeed. The Senate began laying the groundwork for Thursday’s vote almost immediately after Obama won election last November, if not before. Kennedy, who called healthcare reform “the cause of his life," and centrist Finance Committee Chairman Max Baucus (D-Mont.) forged separate paths toward their mutual destination that converged in the measure Reid ushered through the Senate floor.

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Kennedy’s Health, Education, Labor and Pensions Committee, shepherded by Dodd, and the Finance Committee each spent months drafting legislative proposals and weeks in open session stitching them together, sometimes late into the night or the wee hours of the morning.

Baucus wavered from hero to villain in the eyes of the Democratic Party’s left wing during the course of the bill’s advancement. His early abandonment of the public option, motivated by his belief that it would never win the support of 60 senators, aggravated liberals. The months Baucus spent in closed-door meetings with the so-called Gang of Six senators — three Democrats and three Republicans — failed to produce a compromise. The bipartisan talks, however, succeeded in pushing healthcare reform well past its original August deadline as well as providing Democrats with a legitimate claim they reached out to the minority party.

That Reid would ever be able to bring together all 58 Democrats and the two Independents who caucus with them was in doubt as recently as Saturday, until centrist Sen. Ben Nelson (D-Neb.) struck a deal with Reid on new language restricting federal funding from paying for abortion coverage — and receiving preferential treatment for his home state’s Medicaid program and healthcare interests.

The Senate’s liberals went along, in some cases with open reluctance, echoing Obama’s sentiments that a bill that extends health insurance coverage to 31 million people, enacts strict new consumer protections for insurance policyholders and actually reduces the federal budget deficit is something to be celebrated, not mourned. If the legislation is to find its way to Obama’s desk after the new year, he has work to do to convince House liberals of the same.

The Senate bill would spend $871 billion over 10 years on health insurance tax credits for low- and middle-income people and an expansion of Medicaid while cutting Medicare and other program spending by $483 billion, raising $614 billion in new tax revenue and cutting the federal budget deficit by $132 billion. The measure would create a health insurance exchange, enact strict new regulations on health insurers and put in place measures to reform the way healthcare services are delivered.

This story was updated at 8:35 a.m.

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