Democrats have little time to savor the narrow passage of their historic heath care overhaul in the House of Representatives as attention turns to the deeply divided U.S. Senate. Majority Leader Harry Reid's challenge is to corral enough votes to bring a companion bill to the floor of his chamber before a White House-imposed Christmas deadline.
The Nevada Democrat, facing a tough re-election back home, threw Senate negotiations into turmoil recently when he embraced a public insurance option.
The option is a key component of the newly minted House bill, but is opposed by a handful of moderate Senate Democrats, as well as Sen. Joseph Lieberman, an independent.
And Reid needs the support of all 58 Senate Democrats, as well as Lieberman and fellow independent Sen. Bernie Sanders of Vermont, to secure the 60 votes necessary to block a Republican filibuster.
Reid has said that the public insurance option he supports would allow states to opt out of the program. An analysis of the cost of the proposed Senate plans by the nonpartisan Congressional Budget Office is expected later this week.
The House has proposed paying for its plan by increasing taxes on wealthy Americans. The Senate versions have favored taxing generous insurance benefit plans — anathema to union members, and opposed by House leaders.
Reid must first reconcile two competing Senate health care bills in the weeks ahead before moving to a vote. Then the House bill and any health care legislation from the Senate would have to be merged by a joint congressional committee before being sent to President Obama for his signature.
Reid avoided any promises about Senate action. In a statement released after the House vote, he said, "We realize the strong will for reform that exists, and we are energized that we stand closer than ever to reforming our broken health insurance system."
Democrats Celebrate
On the House floor, announcement of the 220-215 vote was greeted by wild applause from the Democratic side of the aisle. Afterward, Rep. Patrick Kennedy, a Democrat from Rhode Island, invoked his recently deceased father. During his four decades in the Senate, Massachusetts Sen. Edward Kennedy made health care reform his life's work.
"My dad was a senator," Kennedy said, "but tonight his spirit was in the House."
House Speaker Nancy Pelosi, the first woman to preside over the House, managed to overcome the defection of 39 Democrats to the "no" column and attract a lone Republican to give her just two more votes than the 218 she needed to get the overhaul legislation passed — and to hand the president a big win for his top domestic priority.
"I thank the president for his tremendous leadership, because without President Obama in the White House, this victory would not have been possible," Pelosi said at a press conference immediately after the vote.
"He provided the vision and the momentum for us to get the job done for the American people," she said.
In a brief appearance Sunday afternoon at the White House, Obama said he was grateful for "courageous" legislators who voted for the House overhaul given "the heated and often misleading rhetoric around this legislation."
"Now it falls on the United States Senate," he said, to deliver the "change we promised to the American people."
"I am absolutely confident it will," he said in an earlier statement, "and I look forward to signing comprehensive health insurance reform into law by the end of the year."
Victory Came With A Cost
But the struggle for passage in the House, after a full day of rhetorical scuffles and contentious debate, came at some cost to Democrats who support a woman's right to have access to legal abortion — presaging what will likely be a topic of considerable debate in the Senate.
To win the votes of conservative party members who oppose abortion, House Democratic leaders endorsed an amendment to their legislation that bars the use of government subsidies to buy any insurance plan that covers the procedure. The move angered many in the party's 190-member House pro-choice caucus, who said they viewed it as an invasion of women's medical privacy. The amendment, however, ensured the politically necessary support of some Roman Catholic lawmakers and the U.S. Conference of Catholic Bishops.
Conservative Democrats won the hard-fought chance to offer the abortion restriction amendment during debate, and with the support of all but one House Republican, it passed by a vote of 240 to 194. Arizona Republican John Shadegg voted "present" to the amendment.
With such close margins and the struggle over the abortion issue, it had been uncertain if Pelosi could gather the votes needed to pass the bill — even though Democrats enjoy an 81-vote edge in the House. But with passage secured, Majority Leader Steny Hoyer joked, "For all of my friends in the press who've been assaulting me in the hallways, asking if we have the votes, the answer is yes."
Earlier Saturday, President Obama, in an unusual weekend visit to the Capitol, personally urged lawmakers to "rise to the moment" and "finish the job."
The House Democrats' plan would cost close to a trillion dollars over the next decade, and would mandate that most employers cover their workers. It also requires people who are not insured through their employers to buy coverage, and it expands government programs to help them pay for that. The bill bars insurance companies from denying coverage to people based on pre-existing conditions, and includes other insurance industry reforms.
Freshman Rep. Joseph Cao of Louisiana was the lone Republican to vote for the bill. He represents a heavily Democratic district, and faces an uphill re-election battle next year. His fellow Republicans were united in the reasons for their opposition. "The American people need to understand this is about a government takeover of the whole health care system," said Georgia Rep. Paul Broun.
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