Senate Democrats beat back GOP alterations to healthcare 'fixes'

Senate Democrats prevail, so far, in keeping the package of healthcare 'fixes' intact. But the House will need to vote on it again to address small adjustments in the part dealing with student loans.

After nearly 9-1/2 hours of back-to-back votes that went until nearly 3 a.m., the Senate reconvenes Thursday morning to complete work on a House package of “fixes” to the sweeping healthcare reforms signed into law on Tuesday.

But anyone sleeping through the late-night action need not worry about missing something big. Some of the particularly tough votes are likely to be repackaged as campaign ads for fall midterm elections.

In a process dubbed vote-a-rama, the Senate voted down 29 Republican amendments to healthcare reform, on near-party-line votes. The votes, however, did put senators on record on issues ranging from tax hikes and back-room deals for certain states to gay marriage in the District of Columbia and whether to ban Medicare payments to cover Viagra for sex offenders.

Healthcare 101: What the bill means to you

Senate leaders had hoped to pass the package of House fixes without amendment, thus sending this carry-on bill straight to the Oval Office for the president’s signature. That meant beating back all GOP amendments, including many that are popular with the public.

“I will oppose any amendment no matter how good that amendment may be,” said Sen. Dianne Feinstein (D) of California, noting the importance of keeping the healthcare legislation intact.

'Fixes' package back to the House

With the occasional exception, Democrats did in fact hold together through 29 tough votes, defeating every one. But Republicans found two minor procedural points, expected to be raised on the floor Thursday, that will require adjustments in a student loan measure included in the healthcare fixes. That means a revised fixes package will need to go back to the House for a re-vote. Anticipating this possibility, House leaders are holding the House in session through the weekend before a two-week break, if necessary.

“These changes do not impact the reforms to the student loan programs and the important investments in education,” said Jim Manley, a spokesman for Senate majority leader Harry Reid.

The essential point, Senate Democratic leaders say, is that the Senate is on track pass the House fixes without any substantive changes. Many amendments proposed by Republicans would have significantly reworked the new law.

Amendments Republicans offered

Sen. Judd Gregg (R) of New Hampshire opened the sequence of votes with an amendment to block the use of some $500 billion in Medicare funding for a new entitlement – an amendment that would have gutted financing for the healthcare bill. He proposed, instead, that any savings in Medicare to be used to boost Medicare solvency. Two Democrats, Sens. Ben Nelson of Nebraska and Jim Webb of Virginia, joined all Republican senators in voting for this amendment, which was tabled (derailed) by a vote of 56 to 42.

Sen. John McCain (R) of Arizona lost his bid to cut all sweetheart deals from the package of fixes, including those for Louisiana, Tennessee, Hawaii, Montana, Connecticut, among others. The amendment was tabled by a vote of 54 to 43. Democratic Sens. Evan Bayh of Indiana, Blanche Lincoln of Arkansas, and Nelson of Nebraska voted with Republicans.

In a classic campaign-style amendment, Sen. George LeMieux (R) of Florida proposed requiring all members of Congress to limit themselves to Medicaid as their sole federal health insurance benefit, thus holding themselves to what they legislate for others.

“What my colleagues don’t want to talk about is that Medicaid is a failing system where doctors refuse to see patients and pharmacies won’t fill prescriptions,” he said Wednesday. “Now we are putting 16 million additional Americans into it and degrading the quality of care even further.” The bid failed on a straight party-line vote, 40 to 51.

Democrats charged that some amendments, such as one to bar federal funding for insurance coverage of erectile dysfunction drugs for sex offenders, were designed solely to force Democrats to take votes that could be later used against them in election campaigns. That amendment by Tom Coburn (R) of Oklahoma was tabled on a vote of 57 to 42, with moderate Democratic Senators Bayh and Nelson again breaking ranks.

But on at least two procedural issues, Republicans did get the support of a critical voice: the Senate parliamentarian. Democrats and Republicans have both been vetting strategies on this legislation for weeks with the parliamentarian. As of Friday, Democrats were convinced that the package of fixes the House passed on Sunday would also pass muster in the Senate. On Wednesday, parliamentarian Alan Frumin gave advisory opinions signaling that if Republicans brought these two procedural points to the floor, he would support them.

With little chance now to alter the bill, Republicans are focusing the last hours of floor time on taking their case to the American public concerning why the new law – especially with “fixes” – is a flawed strategy. “This add-on bill took a terrible health spending bill and made it even worse,” said Senate Republican leader Mitch McConnell.

The House reconciliation package increases subsidies to make the required mandates more affordable to poor and middle-income families. It decreases the penalty on individuals who do not purchase health insurance to $695 a year for each household member, down from $750 in the 2009 Senate bill. It also phases out the “doughnut hole” in the Medicare prescription-drug program over 10 years, beginning with a $250 annual rebate for seniors who fall into this gap in federal payments in 2010. [Editor's note: The original version of this paragraph misstated the penalty for noncompliance with the mandate to buy health insurance.]