Senate Passes Sweeping Health Care Reform, but Trouble Lies Ahead

After nearly a year of negotiations, concessions, fits and starts, the U.S. Senate passed sweeping health care reform legislation in an early-morning vote Thursday, by a party-line tally of 60 to 39.

The Christmas Eve vote was the first on record for the Senate in nearly a century, and marked the end of a grueling work session for the lawmakers, who had plowed through three working weekends since Thanksgiving, often voting into the early morning hours, to meet Majority Leader Harry Reid's goal of passing a health bill before Christmas.

Before senators cast their votes Thursday morning, Republican Leader Mitch McConnell went to the Senate floor to call the bill "a monstrosity" and vowed to stop it. "This fight isn't over," he said. "My colleagues and I will work to stop this bill from becoming law." He also derided the Senate process as a collection of "party-line votes and sweetheart deals."

Reid followed McConnell and praised the bill his Democratic colleagues were about to pass as one that will expand health insurance, cuts medical costs and help people who need it. With the late Ted Kennedy's widow, Victoria Kennedy, watching from the gallery above the Senate floor, Reid also acknowledged the long road ahead. "This is just the beginning," he said. "With Senator Ted Kennedy's booming voice in our ears – with his passion in our hearts – we say, as he said: The work goes on, the cause endures."

Vice President Joe Biden presided over the chamber, while senators sat at their assigned ceremonial desks and called out their votes as the clerk called the roll. Republicans emphatically yelled "no!" while Democrats voted "aye," most with relieved smiles. When the clerk called his name, Sen. Robert Byrd bellowed, "This is for my friend Ted Kennedy. Aye."

Perhaps because of the early hour, Harry Reid accidentally called out "no!" but quickly clarified that he meant for vote "aye," to the laughter of the chamber.

The approved Senate bill would reform health insurance regulations, require individuals to purchase insurance, and create a subsidy from the federal government for those who cannot afford it to purchase it on a health exchange managed by the federal government. To pay for the expanded coverage, the bill raises payroll taxes for income over $250,000, imposes a 40 percent excise tax on high-dollar insurance policies, and creates new taxes and fees for medical suppliers.

Although the Senate Democrats succeeded Thursday morning, the bill they passed differs significantly from the House's legislation. While the House chose to create a public health insurance option, the Senate did not. The House bill raises taxes on the wealthy with a 5 percent increase on people making more than $500,000. The Senate increases the Medicare payroll tax and creates the "Cadillac tax," which could hit some middle-class workers by taxing high-end health plans.

The Senate also has more restrictive language preventing illegal immigrants from accessing health exchanges, while the House measure lays out prohibitions on indirect abortion funding. With so many issues to resolve in the bills and such slim majorities to pass them, simmering internal party battles could spill into public view as liberal and conservative forces of the Democratic party vie to control of the conference committee process.

President Obama told PBS' Jim Lehrer on Wednesday he is "very satisfied" with the Senate bill, and predicted a smooth road ahead as the House and Senate meet to work out their differences. "You know, what's interesting is, the House version and the Senate version are almost identical." Obama said he would be directly involved in the conference process, but declined to list specific provisions that would be deal breakers for him.

Other potential negotiators were not so optimistic. In the days leading up to the vote, moderate Democratic senators warned their House colleagues that any changes to the Senate bill on abortion, taxes, or the public option could jeopardize health reform altogether.

"It is very clear that the final bill to pass in the United States Senate is going to have to be very close to the bill that has been negotiated here," Sen. Kent Conrad (D-N.D.) said on "Fox News Sunday." "Otherwise, you will not get 60 votes in the Senate."

Sen. Ben Nelson (D-Neb.) reserved the right to vote against the conference "if there are material changes," and Sen. Mary Landrieu (D-La.) told C-SPAN the "Cadillac" tax would have to be a part of any final package she votes for. Both Nelson and Landrieu won hundreds of millions of dollars in the Senate bill for their states, which Republicans and even some Democrats derided as unfair to other states' taxpayers.

As vocal as the senators were, House Democrats -- conservatives and liberals -- began to draw their own lines for negotiations, leaving no doubt that the Senate will not dictate the final bill in their minds. House Majority Leader Steny Hoyer told reporters last week, "Many of you have asked if the House is simply going to take the Senate bill. That's not going to happen."

On Wednesday, Rep. Bart Stupak (D-Mich.) told CNS News that pro-life Democrats such as himself are not looking for a compromise with the Senate on abortion funding, which his amendment to the House bill prohibits. "Members who voted for the Stupak language in the House -- especially the Democrats, 64 Democrats that voted for it -- feel very strongly about it," he said. "It's the principal belief that we have. We are not just going to abandon it in the name of health care."

That same day, a senior House Democrat, Rep. Louise Slaughter, penned an op-ed for CNN.com that blasted the Senate bill and its lack of a public option as too watered-down to be called real reform. "A conference report is unlikely to sufficiently bridge the gap between these two very different bills," she wrote. "It's time that we draw the line on this weak bill and ask the Senate to go back to the drawing board."

With the Senate bill now passed, House and Senate negotiations will formally begin in January.