With no Republican votes – and no votes to spare – Senate Democrats opened debate on historic overhaul of how the US healthcare system delivers services and how Americans pay for them.
The bill promises to expand access to healthcare to some 31 million Americans at no net cost to the federal government. At 2,074
pages, it’s the most wide-ranging and complex bill to come before the Congress since the New Deal.
But for majority leader Harry Reid, Saturday night’s 60-to-39 vote is only the first 60-vote hurdle in a long race to passing a bill in the Senate. It cleared the way for debate to begin after the Thanksgiving break. But comments made by several moderate Democrats – Democrats without whom the bill has little chance of passing – sought to infuse the historic moment with a measure of sobriety.
Their statements suggest the shape of the debate ahead for the Senate healthcare reform bill in the coming weeks: the existence of a public option and its size, ways to contain costs, and provisions about limiting access to abortion services, among other issues. At the same time, they highlight the enormity of the work that remains.
One of the last two Democrats on the fence to be persuaded to vote "yes" Saturday was Sen. Mary Landrieu (D) of Louisiana. In discussions with Senator Reid, Senator Landrieu won more than $100 million to help her state, still reeling from hurricane Katrina, to help pay for healthcare for the poor. Yet her support remained tepid.
“I have decided that there are enough significant reforms and safeguards in this bill to move forward, but much more work needs to be done,” said Landrieu.
“I am opposed to a new government administered public healthcare plan as a part of comprehensive health care reform, and I will not vote in favor of the proposal that has been introduced by leader Reid as it is written.”
If Saturday's vote is the model of how Democrats can get to 60 votes on healthcare reform – avoiding a filibuster – then Reid will need Senator Lincoln. Yet on the left wing of the Democratic caucus, some liberals went on record saying their vote is in doubt if the public option is weakened during debate.
“While I voted to proceed to the health care legislation tonight, I have made it clear to the administration and Democratic leadership that my vote for the final bill is by no means guaranteed,” said Sen. Bernard Sanders (I) of Vermont, in a statement after the vote.
To rally all 60 members of the Democratic caucus for the first key procedural vote on this legislation Saturday was an epic challenge for Reid, who faces his own tough reelection race next year. In addition to disputes over the public option, the majority leader had to work through deep divisions in his caucus over restrictions on abortion, access for undocumented workers, the scope of mandates on individuals and small businesses, and how to rein in the cost of healthcare.
Advocacy groups have already spent a record $170 million on both sides of healthcare debate. Opponents of the Senate bill say they will go after divisions in Democratic ranks.
“[President] Obama and Reid wanted debate, so now they’ll get debate on their cloaked provisions that would cover abortion-on-demand in proposed new government-run and government-subsidized insurance plans,” said Douglas Johnson, legislative director for the National Right to Life Committee in a statement after the vote.
Republicans, who unanimously opposed the bill, are already releasing new ads to target Democrats in conservative districts who voted to move the bill to the floor. “The American people expect us to try to change this monstrosity, and I assure you, we are going to try to change it,” said Senate Republican leader Mitch McConnell to reporters on Saturday.
After the vote, Democrats expressed confidence that, despite the opposition, history was on their side.
“Tonight the Senate voted to open one of the most important debates in its history,” said Senate majority whip Richard Durbin, after the vote. “For the first time we will squarely face the healthcare crises American families face every day. We need to bring down costs; give families a fighting chance against insurance companies that deny coverage; and expand the reach of healthcare protection to more Americans. Now, the real debate can begin.”
And for Reid the way ahead only gets more difficult. “The road ahead will be the toughest stretch. But we have momentum and I will keep this process moving forward,” added Reid after the vote.
Follow us on Twitter.