Senate votes final passage of healthcare bill

UPDATED, 8:12 a.m. -- The Senate early on Thursday approved, 60-39, sweeping legislation to remake the nation's healthcare system that seeks to expand access to healthcare coverage and rein in insurance companies -- an effort that has eluded many past presidents and Congresses, but which now appears likely to become a reality in the next few months.

The vote came just in time for the White House-imposed Christmas deadline. But key senators said on Wednesday afternoon that getting the bill to President Obama's desk in time to allow him to tout the achievement of a major campaign pledge during the State of the Union speech is unrealistic. Obama is expected to deliver the State of the Union address sometime in late January.

"We need a break to go home to our families, to repair some relationships with our spouses and to relax and recharge and come back. And I think we'll have a much more positive outcome after that break," Senate Majority Whip Richard Durbin, D-Ill., said. "But it does take time away from January, and it may mean that this takes a little longer."

He declined to speculate on when a conference with the House would be complete.

Senate Finance Chairman Max Baucus, D-Mont., said key players will begin calling each other next week to begin conference negotiations.

There were moments of both humor and poignancy during Thursday's 7 a.m. vote, which followed a month of often rancorous floor debate. Sen. Jim Bunning, R-Ky., was the only senator not voting in a tally which -- reflecting a series of procedural votes earlier this week -- broke down strictly along party lines.

Weary from a long slog to this point, Senate Majority Leader Harry Reid, D-Nev., initially voted "no" by accident, and then put his head down on the podium after laughing and changing his vote to "yes." Wisecracked Reid, ""I spent a restless night trying to figure out how I can find some bipartisanship."

And the body's longest serving member, 92-year old Sen. Robert Byrd, D-W.Va., raised his hand when his turn came to vote and declared: "This is for my friend Ted Kennedy. Aye."

Kennedy, who had made reform of the nation's healthcare system a career-long cause, was instrumental in the beginning of the negotiations on the pending legislation -- but died of a brain tumor last August after serving nearly 47 years in the Senate.

Although the Senate bill expands Medicaid and provides subsidies for people to buy insurance through an exchange, it does not include a public option, previously a priority for liberals and Obama. Instead, the $871 billion legislation limits insurance company overhead, bans insurers from discriminating against pre-existing conditions and creates an exchange for those without employer-sponsored insurance that would place other requirements on insurers.

While the Senate bill squeaked by with just enough votes for passage, the House tally was close as well, passing 220-215, meaning neither chamber has much margin for defections.

House progressives plan to push back hard against the lack of a public option in the Senate measure. A senior Democratic aide predicted the party's liberal base needs to see another attempt at the public option to assure them everything was done to include one. But the political will for such a move is missing among moderates.

Liberals insist a government-run plan will show up in future legislation. "The issue of the public option will be revisited. I guarantee it," Senate Health, Education, Labor and Pensions Chairman Tom Harkin, D-Iowa, said.

Senate Democratic leaders were forced to strip the public option from the bill after party moderates objected, thereby denying leadership the 60 votes needed to clear procedural hurdles throughout the week. The House-passed healthcare overhaul bill includes a public option, though leaders have indicated they could accept a bill without one.

The House Progressive Caucus put leaders on notice this week that they will also push for the higher subsidies in the House bill and a national insurance exchange, rather than the state-based ones in the Senate bill. Progressives claim the provision in the Senate measure endangers the overhaul by putting it "at the hands of hostile governors."

How exactly the House and Senate will marry their bills is unclear, but staff will do much of the heavy lifting over the Christmas break. A conference committee is expected to convene, but the intensity of its role is not yet worked out.

Reid said he intends to head home to Nevada and take a few days "to watch my rabbits eat my cactus" before he makes any decision on the conference process.

Each chamber also must reconcile how they plan to pay for the overhaul. The senior Democratic aide said the House is prepared to accept the excise tax on high-cost, so-called "Cadillac" health plans in the Senate measure with assurances it will not affect union families.

House Democrats will seek to raise the premium thresholds for what constitutes a high-cost plan. To fill that gap, they could counter with a version of the House's tax on the wealthy by raising the income level subject to the surcharge. The House version of the bill now would raises income taxes on individuals earning over $500,000 and couples making more than $1 million.

The gap between how each bill handles federal funding of abortion also is expected to cause some problems as the House and Senate marry their bills. "Bart Stupak tells me they're not going to budge," Sen. Orrin Hatch, R-Utah. He was referring to the Michigan Democrat responsible for more restrictive House language than even a provision in the Senate bill negotiated by Sen. Ben Nelson, D-Neb. The latter provision, which was key to bringing Nelson aboard the final bill, requires segregated payments to plans that accept federal subsidies.

Nelson prefers the Stupak language, but negotiated the Senate deal when the more restrictive provision could not gain 60 votes in that chamber.

Lawmakers also must work out differences on the Senate's stricter treatment of illegal immigrants and plug a gap in Medicare's prescription drug coverage known as the doughnut hole. Senators did not fully address the doughnut hole in their legislation, but pledged to find a way to do so in conference.