Senate Says Yes To Landmark Health Bill In the early hours of Christmas Eve, senators voted in favor of sweeping health care legislation that would expand insurance coverage to millions of Americans. The House passed its version in November; next up, a conference to reconcile the two bills.
NPR logo Senate Says Yes To Landmark Health Bill

Senate Says Yes To Landmark Health Bill

Senate Majority Leader Harry Reid of Nevada (center) answers questions outside the Senate chambers Thursday after the Senate passed the health care reform bill. With Reid are (from left) Senate Finance Committee Chairman Max Baucus, Senate Majority Whip Richard Durbin, and Senate Banking Committee Chairman Christopher Dodd. Mannul Balce Ceneta/AP hide caption

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Mannul Balce Ceneta/AP

Senate Majority Leader Harry Reid of Nevada (center) answers questions outside the Senate chambers Thursday after the Senate passed the health care reform bill. With Reid are (from left) Senate Finance Committee Chairman Max Baucus, Senate Majority Whip Richard Durbin, and Senate Banking Committee Chairman Christopher Dodd.

Mannul Balce Ceneta/AP

After more than three weeks of rancorous debate and a series of hard-fought procedural victories, Senate Democrats passed a bill that provides a blueprint for a sweeping overhaul of the nation's health care system.

The achievement brought President Obama and Democrats a step closer to the most significant expansion of health coverage since Medicare was created more than four decades ago.

As Democratic leadership celebrated the victory. Sen. Chris Dodd of Connecticut said the health bill's passage just before Christmas represented a gift for all Americans. He said it would lift "the burden of fear from their shoulders" about health coverage. "We're now on the cusp of achieving something that has defied generations," he said.

Sen. Charles Schumer (D-NY) praised the bill for cutting costs while also extending health coverage to 31 million people. "This is an amazing accomplishment," he said.

Inside The Senate Bill

No Public Option: Instead, the Office of Personnel Management, which supervises health plans for federal workers, would oversee national plans offered in the health insurance exchanges.

Mandates: Requires most people to have health insurance or pay a penalty, which starts at $95 in 2014 and reaches $750 two years later. Subsidies available for some.

Restrictions: Insurers would be barred from rejecting applicants because of pre-existing conditions once the exchanges are operating — 2013 in the House bill and 2014 in the Senate version.

Employer Requirements: Employers do not have to provide health insurance, but companies with over 50 employees could be fined for any employee whose health insurance the government ends up subsidizing.

Funding: Mainly by taxing insurers on their high-cost health insurance plans and increasing Medicare payroll taxes. Imposes a 40 percent tax on "Cadillac" health insurance plans. Charges a 10 percent tax on indoor tanning services, which is expected to raise $2.7 billion in the first 10-year period.

Abortion: Perhaps the thorniest issue, the Senate bill would allow insurance plans operating in newly created exchanges to offer abortion services, but enrollees would have to write separate checks for the abortion coverage.

In remarks after the Senate action, President Obama said, "With today's vote, we are now incredibly close to making health insurance reform a reality in this country. Our challenge, then, is to finish the job." He gave no deadline for melding the Senate bill with the House version passed last month into unified legislation for his signature.

Preliminary talks on merging the two bills are expected to begin over the holidays, but the main work most likely won't get under way until the new year.

As senators gathered to cast their votes, Majority Leader Harry Reid (D-NV) invoked President Harry Truman's failed efforts to bring about national insurance coverage during the 1940s. "How much longer can we afford to put this off?" Reid asked. "We don't have the luxury of waiting."

The 60-39 vote along party lines took less than 15 minutes Thursday morning, with Sen. Debbie Stabenow (D-MI) casting the decisive 51st vote in favor.

Independents Joseph Lieberman of Connecticut and Bernie Sanders of Vermont voted with the Democratic caucus. No Republicans, including Maine moderate Olympia Snowe, voted for the bill.

Republicans were withering in their criticism of what they deemed a budget-busting government takeover. Senate Minority Leader Mitch McConnell of Kentucky blasted the bill, saying it "fails to lower costs." He warned that senators "who voted for this bill will get an earful" from dissatisfied constituents when they return home, and he vowed Republicans will continue to fight against health overhaul becoming law.

House Minority Leader John Boehner assailed the bill moments after passage. "Not even Ebenezer Scrooge himself could devise a scheme as cruel and greedy as Democrats' government takeover of health care," the Ohio Republican said in a statement.

Compare The Bills

A closer look at how the House and Senate versions compare, and where the chambers might clash.

"Sen. Reid's health care bill increases premiums for families and small businesses, raises taxes during a recession, cuts seniors' Medicare benefits, adds to our skyrocketing debt, and puts bureaucrats in charge of decisions that should be made by patients and doctors," he said. "The bill also authorizes taxpayer-funded abortions, violating long-standing federal policy. It's no coincidence that the more the American people learn about this monstrosity, the more they oppose it."

Sen. Orrin Hatch (R-UT) contended that it "just might wind up being the most widely hated legislation of the decade."

Despite this unflinching Republican opposition — and late carping by liberals that compromises to forge a filibuster-proof bloc went too far — Senate Democrats closed ranks behind legislation that they say would expand coverage to tens of millions of Americans, restrict the ability of private insurers to deny coverage and eventually trim the nation's budget deficit. The price tag for the Senate bill: $871 billion over a decade.

President Obama acknowledged that the road so far has been rough, during an interview with NPR's Robert Siegel and Julie Rovner Wednesday. The president made the case, however, that the struggle against what he called politically and ideologically driven opposition has been worthwhile.

Democrats assert that the Senate bill would fundamentally transform the health care system in the country, beginning with restrictions on private insurance companies. Obama told NPR that "a patient's bill of rights on steroids" lies inside the Senate bill.

Various provisions would prevent insurers from dropping ill patients and denying coverage to those with pre-existing conditions. The bill would also require that individuals buy insurance, if they don't already have it from their employers or existing government programs, such as Medicare.

Federal subsidies would be offered to help low-income people afford coverage. A financial penalty would be levied against people who fail to buy insurance.

But the wrangling over health overhaul is far from over. Democrats have little room to maneuver as they begin to reconcile the House and Senate versions. The two chambers are still divided over how to finance the expanded coverage, whether to create a government-run plan, and, in particular, how to restrict the use of federal funds for abortions.

"The Senate bill will be the main legislative vehicle, because it doesn't happen without preserving the 60 votes in the Senate," says Drew Altman, the president of the nonpartisan Kaiser Family Foundation. "But you can't ignore the House. There are powerful committee chairs who have worked this issue for most of their professional lives."

With additional reporting from NPR's Kevin Whitelaw and The Associated Press