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There was more than a little drama on the Senate floor yesterday. First was the surprise return of Senator Ted Kennedy. He's been home in Massachusetts, being treated for a brain tumor, and he was greeted with a standing ovation from his Democratic and Republican colleagues and also by visitors in the galleries. It was a violation of Senate rules, but no one bothered to enforce them.

Kennedy came to the Senate floor to deliver what everyone assumed would be the decisive vote on a Medicare bill that's been stalled in the Senate, but in a stunning reversal, enough Republicans switched their votes so that the bill didn't just pass, it passed by a veto-proof margin. NPR's Julie Rovner has the details.

JULIE ROVNER: Kennedy's unexpected appearance on the Senate floor yesterday was just the latest twist in the saga of a Medicare bill that's defied predictions at every turn. And almost until the vote was over, it seemed his was the vote that would send President Bush the bill to cancel a 10.6 percent pay cut to doctors. Then Republicans started to change their votes.

Mr. BOB LASZEWSKI (Health Policy Analyst): Lots of Republicans who said they weren't going to change their mind at the last minute. I mean, this was a stampede at the end.

ROVNER: That's health policy analyst Bob Laszewski. He says that passage of the bill is significant, not just because it cancels the cut for doctors but because of how that's paid for, by trimming payments to private insurance plans that serve Medicare patients.

Mr. LASZEWSKI: Really, Democrats used the impending 10.6-percent cut to accomplish something, I think, that they would consider more important, and that is to begin to stem the tide against the expansion of private Medicare.

ROVNER: Indeed, Republicans and Democrats always agreed that doctors shouldn't have their Medicare pay cut, but they divided over where to get the money. Democrats, like Senator Dick Durbin of Illinois, say the private plans are an obvious target because they're already getting overpaid by Medicare.

Senator RICHARD DURBIN (Democrat, Illinois): We believe that they can cut back on their profits, they can reduce their costs, and they can still help seniors.

ROVNER: But Republicans, like Utah's Orrin Hatch, have steadfastly refused to cut the private plan program known as Medicare Advantage.

Senator ORRIN HATCH (Republican, Utah): We finally figured out how to provide choice to Medicare beneficiaries in both rural and urban areas and how to pay plans appropriately. But my friends on the other side cannot leave a good thing alone and insist on making changes to a program that is working very well today.

ROVNER: The bill passed the House two weeks ago by an overwhelming 355-to-59 margin, way more than the number needed to override the veto threatened by President Bush. But when it got to the Senate, Republicans refused to go along. There, it fell one vote short of the 60 required to move to a final vote.

Enter the American Medical Association. It was the nation's biggest independent spender on television last week, with ads like this one, targeting Republicans who voted against the bill.

(Soundbite of political advertisement)

Unidentified Man: A group of U.S. senators voted to protect the powerful insurance companies at the expense of Medicare patients' access to doctors.

ROVNER: It was clear from yesterday's debate at least some senators had been rattled by the campaign. One was Texas Republican John Cornyn. After he voted against the bill, the Texas Medical Association unceremoniously yanked its support for his re-election campaign. Cornyn tried to make it up by offering a bill to fix doctors' Medicare problems not just this year, but into the future.

Senate Finance Committee Chairman Max Baucus quickly batted Cornyn down.

Senator MAX BAUCUS (Democrat, Montana): It's a big warm kiss on doctors that shows them that they love doctors, when, in fact, this is going nowhere.

ROVNER: But it was still unclear as of Tuesday if any Republicans would switch their votes, leaving Democrats one vote short of the 60 needed to get the measure to President Bush. So Kennedy called Senate Majority Leader Harry Reid Tuesday night, volunteering to fly back to Washington for the vote.

In the end, it turned out Kennedy's vote wasn't necessary. Nine Republicans switched from no to yes. The final tally was a veto-proof 69 to 30, with only Republican John McCain noticeably absent. Julie Rovner, NPR News, Washington.

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