Senate Democrats passed sweeping healthcare reform legislation early Christmas Eve day, putting the United States on the brink of the largest expansion in medical coverage since the creation of Medicare and Medicaid.
The 60-to-39 vote split along strict party lines, with 58 Democrats and two Independents voting for the bill, and all Republicans unanimously voting against it.
Both parties described the vote as historic, although for different reasons. To the victorious Democrats, it was a signal moment, the sort of thing that had brought many to Washington in the first place.
"Today I cast one of the defining votes of my Senate career," said Sen. Tom Harkin (D) of Iowa, chairman of the Senate Health, Education, Labor and Pensions Committee.
To Republicans, the vote portends a disastrous increase in government intervention in the private market that the nation will live to regret.
"This legislation is an abomination in process and substance," said Sen. Richard Shelby (R) of Alabama.
Seldom, if ever, in US history has the partisan split on such an important legislative step been so stark. The divide, plus lingering bitterness from a polarized and brutal debate over the issue, could make it far more difficult for the Senate to engage in the nation's business in months and years ahead.
What happens next
The Senate vote marks the beginning of the end for the long march of healthcare reform through the US legislative system. The Senate bill must now be merged with the House version of healthcare reform, approved in November. Substantial differences between the two approaches remain, particularly in regard to antiabortion language, methods of financing, and a governmnt-run public option insurance plan.
A conference committee of members from both chambers will struggle over this harmonization. In its own way, that task could be almost as difficult as the Senate debate, as lawmakers struggle to keep intact the language passed on their side of Capitol Hill.
The Senate bill, like its House counterpart, would prevent the insurance industry from denying benefits to people with pre-existing health conditions. It provides subsidies to help low- and middle-income residents purchase that insurance. And it establishes state marketplaces, called "exchanges," whereby individuals without employer-provided insurance, and some small businessess, could buy coverage.
Insurance industry wary
Reaction from the insurance industry was negative, though guarded. In a statement, Karen Ignagni, head of America's Heath Insurance Plans, said providing all Americans with health coverage is crucial for the country but that specific provisions in the Senate bill would increase healthcare costs, reduce coverage options, and disrupt current insurance arrangements.
"These issues can and should be addressed if healthcare reform is going to fulfill the promise of providing all Americans with guaranteed access to affordable, portable healthcare coverage," said Ms. Ignagni.
Seniors' lobby pleased
The powerful US seniors' lobby, in contrast, welcomed the Senate's action. By passing the bill, senators have brough the nation closer than ever to meaningful reform, said A. Barry Rand, head of the AARP.
The legislation prevents coverage denials, limits insurance companies from charging seniors much more for coverage due to their age, and fills gaps in Medicare's prescription-drug coverage, said Mr. Rand.
"AARP thanks the Senate for advancing this critical legislation," he said in a statement.
Unusual timing for a vote
It was the first time the Senate voted on the day before Christmas since 1895, according to the Senate Historical Office. For some of those present, the vote had an extra, personal dimension.
Rep. John Dingell (D) of Michigan also witnessed the Senate action. Representative Dingell, a longtime champion of his state's auto industry, has fought for expanded healthcare his whole career – as did his father, also a Michigan congressman.
"This is for me, this is for my dad, this for the country," said Dingell after the vote.
Republicans, for their part, were somber and angry. House minority leader John Boehner called the changes contained within the bill "cruel and greedy."
The partisan divide is such that Democrats now own healthcare reform. If it succeeds in coming years, they may benefit politically. If it struggles, it may drag them down.
Republicans, similarly, own the opposite side of this issue. If the debt skyrockets and the economy struggles, they could look prescient. If the programs succeed, then the Christmas Eve vote could become something analogous to the GOP's opposition to the creation of Medicare – something with which Democrats can assail them at every electoral opportunity.
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