WASHINGTON, Dec. 21, 2009 -- President Obama hailed Senate Democrats' advancing the $871 billion health care bill as a "big victory for American people," even as the legislation lost many of the components he had pushed.
The president took aim at critics who say the health care bill would add to the budget deficit and praised the Senate for standing up to special interest groups.
"I just want to be clear, for all those who are continually carping about how this is somehow a big-spending government bill, this cuts our deficit by $132 billion the first 10 years and by over $1 trillion in the second," the president said today at the White House. "The argument that opponents are making against this bill does not hold water."
But the Congressional Budget Office Sunday revised the original numbers, now estimating that the deficit reduction under the bill could actually be half of the more than $1 trillion forecast for 2020 to 2029.
This is the second time Obama has spoken in support of the Senate health care bill, which is on the road to a final vote on Christmas Eve.
In recent days, the Obama administration has tried to push the point that while the bill may not have everything it and some other Democrats had wanted, it would still have positive ramifications for Americans.
Obama hailed the legislation Saturday as "the largest deficit reduction plan in over a decade," and praised Senate Democratic leaders for making changes that he said would make the health care bill stronger.
Vice President Joe Biden wrote in an op-ed in The New York Times Sunday that "While it is not perfect, the bill pending in the Senate today is not just good enough -- it is very good.
"I share the frustration of other progressives that the Senate bill does not include a public option. But I've been around a long time, and I know that in Washington big changes never emerge in perfect form," Biden wrote.
Moderate and liberal Democrats unified behind a health care overhaul bill in the Senate in the wee hours of the morning today after negotiating behind closed doors in a process that Sen. John McCain assailed as "one of the great Bernie Madoff gimmicks."
In a narrow vote in the wee hours of the morning, Democrats broke a Republican filibuster and inched their sweeping health care package toward passage before Christmas.
Democratic leaders today hailed the support of medical associations. The American Medical Association endorsed the Senate health care bill, with Dr. Cecil B. Wilson, the association's president, appearing with Democratic senators at a news conference.
While it expressed support for the plan, the AMA would like to see measures to repeal the Medicare payment formula for doctors to prevent periodic reimbursement cuts.
All 60 members of the Democratic caucus -- liberals who wanted a public option voted for a bill without one, and moderates concerned about the cost -- voted to limit debate on compromise language introduced Saturday morning. The 40 Republicans opposed and assailed Democrats for crafting back-room deals that benefit a few senators.
"It's one of the great Bernie Madoff gimmicks that I've ever seen, that anybody's ever seen," McCain, R-Ariz., charged on "Good Morning America" today, adding that this was an "unsavory practice that the American people will reject resoundingly."
Senate Majority Leader Harry Reid, D-Nev., today defended the provisions, which include more than a billion dollars in special Medicaid funding for Nebraska, Massachusetts and Vermont and Louisiana; special help for a Montana town dealing with asbestos problems; and an exemption from a new tax for specific non-profit insurance companies in Nebraska and Michigan.
"That's what legislation is all about," Reid said. "It's the art of compromise."
Reid guessed that all 100 U.S. senators have something that's important to them in the health care bill. If they don't, he said, they must not be very good senators.
"If they don't have something important to them, it doesn't speak very well for them," Reid told reporters.
Sen. Chris Dodd, D-Conn., was asked more specifically about Connecticut's gift; an opaquely worded authorization for $100 million to help expand a hospital with specific criteria.
Dodd has admitted he put the provision in the bill to benefit a hospital affiliated with University of Connecticut. But Dodd said today the money will be awarded competitively by the Secretary of Health and Human Services among the more than dozen hospitals nationwide that could qualify.
"This is competitive," he said. "It's not just about my state."
Despite allegations of a corrupt political process, Reid predicted that the Democrats' health care bill in both the Senate and House will become more popular as they are reconciled before being presented to the president.
Democrats Unite on Senate Health Care Bill
The proposal would cost $871 billion over the next 10 years to give access for 31 million Americans who don't currently have health insurance. It counts on lower Medicare costs, taxes on the insurance industry and medical device makes as well as a special tax on high-cost insurance plans, to pay for the legislation.
Every person would be required by the government to have insurance or pay a fine. People making up to $88,000 for a family of four would get help from the government to pay for insurance. Medicaid would be greatly expanded for the poor.
But one of the biggest weaknesses of the bill, McCain said, is that tax increases and cuts in Medicare and other funding would kick in as soon as the bill is passed but the benefits won't begin to accrue until four years later.
"That's nutty stuff ... it's unacceptable," he said.
Republican senators, seeking to delay the vote and turn public opinion even further against it, launched a rhetorical attack on Nelson, the conservative Democrat who withheld his support for a health reform compromise until the last moment.
An agreement on the compromise to bring Sen. Ben Nelson, the final Democratic holdout, onboard with the legislation, was announced Saturday morning. But today's vote signaled that all Democrats will support the bill.
Nelson secured a special break for his state's contributions on Medicaid funding, protected some Nebraska insurers from a new tax in the bill and got Democratic leaders to agree on slightly tougher restrictions on how abortions could be offered in insurance plans under the bill.
McCain criticized Democrats for providing concessions to a few Democrats, such as Nelson, saying it would cost people in other states.
"This was behind closed doors," McCain said. "The Republicans were never brought in to the negotiations and this is what you get -- a split country -- where the American people are opposed to what we're doing and opposed to us."
Senate Minority Leader Mitch McConnell of Kentucky called provisions inserted to woo Nelson's vote a "kind of smelly proposition."
"This is supposed to be all of our health care ... not just for them," he said at a Capitol Hill press conference.
It was not just Nelson's home state of Nebraska that won concessions in closed-door negotiations, but because Nebraska's carve-out is permanent, the conservative Democrat is catching the most fire from Republicans.
Vermont and Massachusetts will also benefit from special treatment in how the federal government subsidizes state Medicaid programs, although supporters argue that those two states were being penalized because they already help provide insurance for nearly all of their citizens.
Republicans vowed to delay a final vote until Christmas Eve, even though the vote this morning effectively broke their filibuster of health reform legislation.
Why is the GOP fighting it when the passage looks clear for Democrats?
"Because they [Senate Democrats] haven't got the American public," McCain said. "They had 60 percent of the United States Senate, 60 percent of the American people are against this. They want it stopped and they certainly -- as they find out more about this unsavory process we've been through, the Cornhusker Kickback, the Louisiana Purchase, the Florida FlimFlam and all of the other kinds of dealing that went on -- they'll find it very distasteful."
As for whether the late Sen. Ted Kennedy, who had fought for health care overhaul much of his Senate career, would approve, McCain said his friend would not like the the partisan nature of the legislation.
"I think that Senator Kennedy would appreciate the outcome," he said. "I don't think he would appreciate it on a party-line vote. There has never been a major reform accomplished in the history of this country that wasn't bipartisan. ... He never engaged in this kind of unsavory process of offering people different deals, which in the end cost people from other states lots of money and puts burdens on them."
Republicans Assail Concessions to Some Democrats
Other goodies were tougher to trace. The bill authorizes $100 million for hospital construction for a medical school opaquely described as "an academic health center at a public research university in the United States that contains a State's sole public academic medical and dental school."
Eleven hospitals would potentially qualify for some of the money, according to Democratic staffers. But the Secretary of Health and Human Services would be in charge of doling the funding out.
On the Senate floor, Sen. Lindsay Graham of South Carolina said the Democrats had to "cook up a deal in a back room that is sleazy in my view."
Republicans would never do that sort of back-room negotiating of a bill of this scope, Graham said.
"We're not going to put the whole nation at risk and take a broken system and make it worse just to get a vote," Graham said. "No way in hell."
"This process is not legislation. This process is corruption," said Sen. Tom Coburn, R-Okla. "It is a shame that the only way we can pass this legislation is to buy votes."
McConnell said Republicans will insist on using all their parliamentary time even after that vote, when it is clear that the bill will pass. If Republicans insist on all their time for debate, a vote on final passage of the bill is likely to occur at 7 p.m. on Christmas Eve.
"People have to show up and vote at least three more times," McConnell said, arguing that time is good for the process as lawmakers and the public read through the bill.
Some liberal Democrats are also unhappy, even though they voted with their caucus. Anti-war Sen. Russ Feingold, D-Wis., who earlier helped break a Republican filibuster of a troop funding bill he opposed in order to make room on the Senate schedule for health care reform, cast blame at the White House for not pushing hard enough to include a public health insurance option.
"Unfortunately, the lack of support from the administration made keeping the public option in the bill an uphill struggle," Feingold said in a written statement.
Feingold supported the bill, however, as did every other Democrat, even though he disliked elements of it.
"While the loss of the public option is a bitter pill to swallow, on balance, the bill still delivers meaningful reform, and the cost of inaction is simply too high," Feingold said.
If Senate Democrats pass their bill later this week as they seem sure to do, the next step will be a post-holiday conference to reconcile the House and Senate versions. Given the real differences between the two, that may not be easy.
The House version includes a public health insurance option, while the Senate version would follow the model of insurance for federal workers, allowing insurers to create national health plans overseen by a federal agency.
There are also differences in how the legislation is paid for: The House taxes wealthy Americans, while the Senate would, among other revenue measures, tax high-cost insurance plans. Unions oppose that measure.
But those fights, assuming Democrats can maintain perfect attendance this week, will wait for after the holiday.