WASHINGTON — Senate passage of health care legislation Thursday opened the final chapter of Democrats’ drive to enact the biggest social policy change in decades, launching a high-stakes effort to reconcile the disparities between House and Senate versions of the bill.
But their hardened differences — on abortion, taxes and the government’s role in the insurance market — may weaken under political pressure to act quickly on President Barack Obama’s goal of overhauling a system that provides world-class care for millions of Americans but is marked by huge gaps in insurance coverage, uneven quality and skyrocketing costs.
Strict party lines
The 60-39 vote on strict party lines came in an unusual Christmas Eve session, with senators gathering at 7 a.m. EST. It was the 25th day of debate, and Vice President Joe Biden made a rare appearance to oversee the roll call.
Obama hailed the Senate action.
“With today’s vote, we are now incredibly close to making health insurance reform a reality in this country,” he said after the vote. “We can’t doom another generation of Americans to soaring costs and eroding coverage and exploding deficits.”
Still looming are volatile debates among Democrats over abortion and a range of proposed health-benefit taxes opposed by organized labor and others.
But other major obstacles are beginning to diminish. One of the most divisive issues among Democrats — the idea of creating a government-run insurance program known as the public option — is now effectively off the table.
And for all the differences between the two bills, they have vast expanses of common ground.
The final bill almost certainly will increase by at least 30 million the number of people covered by government and private health insurance. It will for the first time require most individuals to buy health insurance. But it also will offer federal subsidies to help pay premiums, impose penalties on employers that do not offer workers affordable policies and set up an insurance exchange in which individuals can shop for coverage if they have no job-based option.
Insurance companies will have to end practices — setting caps on total payments, for example, or denying coverage on the basis of a pre-existing condition — that have made it hard for people to get coverage when they get sick or have a chronic disease.
Young adults will be able to stay longer on their parents’ health plan. Families will pay nothing for preventive health care such as well-baby visits and mammograms.
And health care professionals will be given incentives to provide more cost-effective care — and face penalties if they do not.
“This is a victory because we’ve affirmed that the ability to live a healthy life in this great country is a right, not a privilege,” Senate Majority Leader Harry Reid, D-Nev., said after the vote.
But all that comes at a cost. The Senate bill would spend $871 billion over 10 years, although it would raise taxes and cut spending in other areas by even more and so reduce the federal deficit over time.
Despite bipartisan consensus that the status quo is unacceptable, the Senate’s debate on health care began and ended in an especially bitter and personal atmosphere of partisanship. No Republicans voted for the bill, and GOP leaders did everything they could to delay the vote until Christmas Eve. They spent more than 80 hours in Senate floor speeches denouncing the Democrats’ bill as an ill-considered and pork-laden monstrosity that would do little to curb health care costs and insurance premiums.
“This fight isn’t over,” said Senate Republican Leader Mitch McConnell, R-Ky. “I guarantee you the people who voted for this bill are going to get an earful when they finally get home for the first time since Thanksgiving.”
The only Republican who did not vote against the bill was Sen. Jim Bunning of Kentucky, who was absent because of family commitments, his office said.
The House and Senate will not reconvene until mid-January. Democrats hope to send a final bill to the White House in late January or early February.