Health bill passes with 1 GOP vote

WASHINGTON —  After months of wrangling over how to reshape the nation’s healthcare system, the last of five congressional committees on Tuesday endorsed its sweeping blueprint for expanding coverage and containing costs.

The 14-9 vote by the Senate Finance Committee sets the stage for the final legislative push amid intense lobbying by healthcare providers, consumer advocates, labor unions and other interest groups.

Tuesday’s vote also offered the first tangible sign that President Obama and his congressional allies might gain some GOP support in their healthcare campaign. Sen. Olympia J. Snowe, a centrist Republican from Maine, joined all 13 Democrats on the panel to back the measure.

“Is this bill all that I would want? Far from it,” Snowe said in announcing her eagerly anticipated vote. “But when history calls, history calls.”

Speaking to reporters at the White House after the vote, Obama praised Snowe -- even as he acknowledged that hurdles remained. “This bill is not perfect, and we have a lot of difficult work ahead of us,” he said.

The bill was designed by committee Chairman Max Baucus (D-Mont.) with an eye toward keeping moderate Democrats on board and creating the possibility of at least some Republican support. But most GOP lawmakers criticized the healthcare campaign Tuesday, renewing complaints that they had been excluded from the process.

“The real bill is currently being written behind closed doors,” said Sen. Orrin G. Hatch (R-Utah), referring to the fact that Senate Majority Leader Harry Reid (D-Nev.) was beginning the process of melding Baucus’ bill with a more liberal version passed in the summer by the Senate health committee.

Reid plans to meet today with Baucus and Sen. Christopher J. Dodd (D-Conn.), the lead champion of the health committee bill. The majority leader has said he hopes to have combined legislation on the Senate floor for debate by the end of the month.

A similar process is underway in the House, where senior Democrats are working to unify their diverse caucus behind a healthcare bill.

All versions of the bill passed by House and Senate committees seek to broaden coverage by requiring people to buy health insurance. In return, they would expand government programs such as Medicaid and create a system of regulated markets where low- and moderate-income Americans and legal immigrants could get federal subsidies to help them buy coverage. In addition, the bills seek to restrain the cost of premiums and prohibit insurers from denying coverage for preexisting medical conditions.

Snowe’s support could make it easier for senior Senate Democrats to convince conservative members of their party to back the chamber’s final legislation and provide the 60 votes necessary to head off an anticipated GOP filibuster. Some Democrats from largely Republican states, such as Nebraska Sen. Ben Nelson, are reluctant to vote for major healthcare legislation that lacks bipartisan support.

But Snowe’s vote also may make it hard for Reid to move the finance committee’s bill far enough to the left to satisfy liberals, who long have complained that the Baucus bill does not do enough to ensure universal coverage.

On Tuesday, Snowe cautioned that if the combined bill strayed too far from Baucus’ proposal and pushed the healthcare overhaul’s cost much higher, she might withdraw her support.

“My vote today is my vote today,” she said. “It doesn’t forecast what my vote will be tomorrow.”

Also warning against radical changes was Sen. Kent Conrad (D-N.D.), who has opposed a government-run insurance plan linked to Medicare.

“That has very serious consequences,” Conrad told his colleagues on the finance committee, warning that hospitals in rural states -- which traditionally receive lower Medicare reimbursement rates -- could be forced out of business.

But many liberal lawmakers, who chafed at Baucus’ insistence on drafting a bill aimed at winning GOP support, continue to push for major changes.

They are trying to convince Reid to include a provision creating a government-run program to offer consumers an alternative to commercial insurance.

In a bid to satisfy Republicans and conservative Democrats who are wary of government involvement, Baucus did not include such a “public option” in his $829-billion bill. Instead, he supported creation of a system of nonprofit insurance cooperatives.

In the committee room Tuesday, Sen. Robert Menendez (D-N.J.) chided those resisting a government plan.

“The healthcare system we have now in America is a private system without government oversight. And it’s not working,” Menendez said, warning that his vote for the bill “comes with the understanding that I fully expect improvements to be made . . . before it becomes a final product in the full Senate.”

Massachusetts Sen. John F. Kerry, another liberal Democrat on the committee, called for tougher penalties on large employers who do not give health benefits to their workers.

Other lawmakers, including Sen. John D. Rockefeller IV (D-W.Va.), expressed concern that too many Americans still would be unable to get insurance.

In an effort to keep the cost of the measure at less than $900 billion over a 10-year period, Baucus limited subsidies to low- and moderate-income Americans -- a compromise that is expected to leave an estimated 17 million eligible people without coverage.

“We are not doing what we set out to do,” Rockefeller warned his colleagues. “It is a step in the right direction, but it is not enough.”

The pressure from the left intensified as labor unions -- which fiercely oppose a provision in the Baucus bill to tax high-end, or “Cadillac,” health plans like those that many union members have -- criticized the finance committee package.

“Senate leaders must make major improvements in the bill before it moves to the floor of the U.S. Senate,” said Gerald W. McEntee, president of the American Federation of State, County and Municipal Employees.

The insurance industry too has assailed the finance committee plan, warning that it would push up insurance premiums.

Other industries, including hospital groups that also are worried the bill will not cover enough people, offered measured praise for the progress of healthcare legislation.

“We are confident that health reform is on track,” said Chip Kahn, president of the Federation of American Hospitals.

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