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Associated Press/Photo by Manuel Balce Ceneta

Finish line

Healthcare | The Senate and then the House put the final touches on the overhaul of healthcare

WASHINGTON-House Democrats Thursday night put the finishing touches on the final piece of legislation in their party's ambitious healthcare overhaul plan. In a 220-207 vote, the House passed a set of changes to the healthcare measure President Barack Obama has already signed into law. This final step clears the way for the president to sign this second bill, which he plans to do early next week.

Earlier in the day, after a moment of silence for the late Democratic Sen. Edward Kennedy of Massachusetts, Senate Democrats set the stage for the House, passing the measure 56-43, with Vice President Joe Biden in the chamber in case his vote was needed to break a tie.

Every Senate Republican voting Thursday afternoon opposed the measure. Three Democrats: Sens. Mark Pryor and Blanche Lincoln, both of Arkansas, and Sen. Ben Nelson of Nebraska joined in opposition. In the House, 32 Democrats joined 175 Republicans to oppose the roughly 153-page set of changes.

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In the Senate, the two parties could not even agree on how to vote: Senate Majority Leader Harry Reid wanted lawmakers to symbolically cast their votes from their desks, a procedure used mostly for confirmation of Supreme Court nominees. Some Republicans, however, did not participate in this ceremony.

The changes to the legislation include striking a controversial part of the statue that would have given Nebraska extra Medicaid dollars-derided as the "Cornhusker Kickback" during initial debate on the bill. It also increases a new tax on drug makers, increases drug benefits for Medicare recipients, boosts healthcare subsidies for low-income people, and increases federal Medicaid payments to states (not just Nebraska this time).

But as millions of Americans begin to find out what a new 2,000-page law will mean to them, it seemed that the congressional healthcare circus just wouldn't stop.

After a marathon voting session that lasted until 2:30 a.m. Thursday morning, Senate Republicans managed to force two changes in the healthcare package that caused the measure to be sent back to the House for its Thursday night vote.

During Thursday's early morning hours, senators learned that a 16-line section of the bill that dealt with Pell Grants for low-income students would have to be deleted. The Senate parliamentarian, consulting with Republicans, ruled that the education provisions violated the strict budget rules Congress has when changing an approved bill.

Even with the changes, Senate Democrats were confident that because the alterations were so minor that the House revote on them would not be controversial like this past Sunday's climactic vote on the overall package.

In fact, the reconciliation package was more popular in the House than the original bill that is now law. House lawmakers demanded this so-called "fix-it" package that makes changes to elements of the Senate bill they didn't like.

Still Republicans used the debate in the Senate to highlight unpopular elements of the overall package.

Beginning at 5:30 p.m. Wednesday, the Senate began nine hours of voting on 29 Republican amendments. By Thursday afternoon's final vote, the Senate had taken 42 consecutive votes, which is a record. Democrats defeated every GOP amendment during the 13 hours of voting.

"This has been a legislative fight that will be in the record books," said Senate Majority Leader Harry Reid.

Senate Minority Leader Mitch McConnell said the GOP wanted "to change the bill, and with a little help from our friends on the other side we could improve the bill significantly."

But Reid accused the Republicans of delaying the inevitable: "There's no attempt to improve the bill. There's an attempt to destroy this bill."

Final Senate passage of these so-called tweaks was assured since it only required a simple majority of 51 votes-unlike the supermajority of 60 needed when the Senate last Christmas Eve passed the healthcare legislation that is now law.

But as Obama spent time in Iowa City, Iowa, Thursday to rally support for the new healthcare landscape, Republicans used the Senate as their bully pulpit to highlight issues they think Americans should know about heading into this November's elections.

In response to Republican threats to repeal the new law, Obama fired back, "My attitude is go for it."

The steady stream of unsuccessful GOP amendments in the Senate included striking the employer mandate, blocking planned cuts to the Medicare Advantage program, barring tax hikes for families earning less than $250,000, exempting various populations from the medical device tax, giving the states the option to opt out altogether, and requiring the president and congressional lawmakers to join in the new insurance exchanges the bill creates.

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