The Senate keeps pushing aside hurdles blocking the huge health overhaul bill. But there are plenty more between the bill and a final vote, which backers still hope to take before Christmas.
The latest obstacle overcome was a nearly weeklong delay caused by a pair of amendments that would have allowed individuals, pharmacies and drug wholesalers to import lower-cost prescription drugs from other industrial countries.
The drug-import amendment, sponsored by Sen. Byron Dorgan (D-ND), enjoyed considerable support in the Senate but could have jeopardized the overall support for the bill from the pharmaceutical industry.
And while President Obama supported the concept both as a senator and as a presidential candidate, his Food and Drug Administration Commissioner Margaret Hamburg wrote to senators last week saying she feared that the proposal could make it easier for counterfeit drugs to enter the U.S.
Such arguments infuriated Dorgan, who has been pushing his plan for more than a decade. "It is an insult, in my judgment, to the American people to say, 'Oh, you can make this work in Europe for the benefit of the consumer to get lower prices, but the Americans don't have the capability to make this happen, don't have the capability to manage it,' " he said. "That is absurd, and I think the safety issue is unbelievably bogus."
Still, after seven days of discussions about how the vote would take place, Dorgan's amendment was ultimately defeated, 51-48. Under the agreement the Senate has been using on the health overhaul, amendments need 60 votes to pass.
What was more surprising, however, was that the Senate also turned down a substitute amendment offered by Sen. Frank Lautenberg (D-NJ). Lautenberg's amendment was essentially the same as Dorgan's but with one enormous difference — it would have taken effect only if the secretary of Health and Human Services first certified that such imports were both safe and would lower costs.
Lautenberg said, "As much as we want to cut costs for consumers, we cannot afford to cut corners and risk exposing Americans to drugs that are ineffective or unsafe."
In the past, the Senate has normally jumped at the chance to appear to be doing something about drug prices, secure in the knowledge that no health secretary has ever been willing to make such a determination. Not this time, however.
Dorgan thundered: "Do not vote for this amendment and go home and say you've done something about the price of prescription drugs, because your constituents will know better."
And for the first time ever, the watered-down importation amendment didn't pass, either. It failed, 56-43. Leaving the importation issue out of the bill actually removed an issue for lawmakers to deal with.
But plenty of hurdles for the bill remain.
One lingering problem is how to make liberals happy now that it appears that both a government-sponsored insurance plan and a proposal to let those not quite old enough for Medicare buy into the program will be dropped from the bill.
One possibility was to require insurance companies to spend a specific amount of each premium dollar on actual medical care, as opposed to administration or marketing or profit.
But there's a problem with that proposal, too.
Over the weekend, the Congressional Budget Office effectively squashed the proposal. It said combined with other new regulations the bill would impose on private insurance plans, limiting administrative costs would basically represent a government takeover of the private insurance industry.
Said the letter: "In CBO's view, this further expansion of the federal government's role in the health insurance market would make such insurance an essentially governmental program, so that all payments related to health insurance policies should be recorded as cash flows in the federal budget."
Meanwhile, one thing that is still being actively negotiated is a way to satisfy anti-abortion Democrats.
Sen. Robert Casey (D-PA), who opposes abortion, is one of the lawmakers working to find compromise on the contentious issue. He says one possibility is to add language that would expand services to pregnant teenagers and young women to help them keep their babies.
"It's one of those rare policy areas where you have people on both sides of the divide on abortion who are going to be very supportive, and have been," Casey said. "But we want more than support — we want to get it in the bill."
Assuming Democrats can get all 60 members of their caucus together, they'll need at least six days for all the procedural votes to get the measure to a final conclusion. That means they pretty much have to tie things up by Thursday if they want to finish before Christmas.