Exchanging gifts

WASHINGTON-With the clock ticking toward 1:30 Monday morning, Sen. Ben Nelson, D-Neb., stood up from his Senate desk when his name was called and changed the Senate healthcare debate with one word: "Aye."

Senate Democrats had finally got their 60th vote. And with Nelson in their corner, even a record-breaking wintry Washington weekend could not stop reformers from inching closer to passing a mammoth healthcare overhaul measure. In a middle-of-the night vote that fell strictly along party lines, the Senate agreed 60 to 40 in favor of moving forward with the trillion-dollar package. Sixty votes were needed to overcome a Republican filibuster.

The key vote was Nelson's, who had called for greater restrictions on the federal funding of abortion. But the Nebraska holdout folded on Saturday, conceding to a compromise deal that was brokered by pro-abortion Sen. Barbara Boxer, D-Calif., favored by pro-abortion House Speaker Nancy Pelosi, and bashed by most of the nation's pro-life groups.

"Sixty U.S. Senators just made history by voting to move forward with a bill that imposes a first-ever mandatory abortion tax on the American people," said Charmaine Yoest, president of Americans United for Life. "We will be making this tragic decision clear to those constituents who have been misinformed that their Senator is pro-life."

While Nelson said the compromise sufficiently blocks tax-payer funded abortions, U.S. Rep. Bart Stupak, D-Mich., who successfully leveraged for tighter abortion restrictions in the already-passed House version of healthcare reform, said that "no one is happy" with the Senate abortion language. "It's a dramatic shift in federal policy," Stupak told CBS News.

Republicans pointed to another reason Nelson jumped on board-a sweetheart deal that Senate Majority Leader Harry Reid gave to Nelson before his Saturday shift. Calling it the "Cornhusker Kickback," healthcare opponents said Nelson's grab echoes the $300 million Sen. Mary Landrieu, D-La., got for her state in advance of a previous healthcare vote (see "Dear Sen. Landrieu," Dec. 19, 2009. )Nelson landed a permanent exemption for his state from paying their share of the costs associated with increased Medicaid enrolment. In other words, while other states will share the cost of an expected 15 million Medicaid expansion by 2019, the federal government will pay for 100 percent of Nebraska's new enrollees, saving the state tens of billions of dollars.

That is not the only gift doled out by Democrats determined to secure President Obama's top domestic priority before Christmas: Vermont and Massachusetts joined Nebraska in getting $1.2 billion in Medicaid assistance. Out West-in Montana, North Dakota, South Dakota, Utah, and Wyoming-doctors and hospitals serving Medicare patients will enjoy higher federal reimbursement rates. And in the senior citizen-laden states of Florida, New York, and Pennsylvania, residents on the Medicare Advantage program will have their benefits protected while the program is cut elsewhere.

In addition, Sen. Chris Dodd, D-Conn., facing a tough reelection campaign next year, got a $100 million stocking stuffer for a university hospital.

"A year after this debate started few people could have imagined that this is how it would end-with a couple of cheap deals and a rushed vote at 1 o'clock in the morning," protested Senate Minority Leader Mitch McConnell. "But make no mistake: If the people who wrote this bill were proud of it, they wouldn't be forcing this vote in the dead of night."

Despite the frantic gift-giving, senators were not in a holiday mood as the debate took over a third straight weekend. Catcalls could be heard during some votes and both parties played the blame game, casting aside old-fashioned Senate collegiality. Democrats called out Republicans for delay tactics, while Republicans accused Democrats of fast-tracking without sufficient debate on what would be the biggest expansion of government since Medicare was established in 1965.

The stage is now set for a final Christmas Eve vote on the 2,733-page measure, which Reid beefed up by an additional 383 pages over the weekend.

The bill uses increased federal subsidies and the expansion of Medicaid to extend coverage to 31 million uninsured Americans. While the Senate bill does not create a government-run plan like the House version, it mandates that everyone have insurance, increases taxes, cuts Medicare by nearly $500 billion, and bars insurance companies from denying coverage over pre-existing conditions.

After Monday morning's vote, only one real mystery remains-if Maine's Olympia Snowe becomes the Senate's only Republican to vote in favor of the package. Democrats, including Obama, who are desperate to give the overhaul some taste of bipartisanship, are expected to continue to court Snowe leading up to Thursday night's final vote.