Stamp of approval

Declaring healthcare a right and not a privilege, Senate Democrats on Christmas Eve have passed their version of a major healthcare overhaul.

Ending 24 days of floor debate, the Senate voted 60-39 to pass the 2,733-page measure that the Congressional Budget Office says would cost $871 billion over the next decade. But opponents claim that the actual price tag may soar to more than $2 trillion over the next 15 years.

Either way, the healthcare reform would become the biggest expansion of the federal government since the creation of Medicare and Medicaid nearly 45 years ago. But this week's healthcare vote took a decidedly partisan track despite the big changes it promises to make to America's medical landscape: Every Senate Democrat supported the legislation. Every Republican opposed it. By comparison, all but six senators voted for the Social Security Act of 1935, and all but 21 supported the Medicare and Medicaid acts of 1965.

"Americans believe that on issues of this importance, one party should never be allowed to force its will on the other half of the nation," said Sen. John McCain, R-Ariz. "The proponents of this bill felt differently. Now, 60 votes represents 60 percent of this body, but I can assure my friends on the other side of the aisle, it doesn't represent 60 percent of the American people."

While the Christmas Eve vote was a landmark step in President Obama's yearlong push to increase the federal government's role in healthcare, a major hurdle still remains.

Lawmakers must merge the Senate bill with the House's version of healthcare reform. With both chambers expected to take a chunk of January off, this reconciliation of the two bills could extend into February, even though congressional leaders would like to have the bill finalized before Obama's State of the Union address set for sometime late next month.

Enough key differences exist in the two versions that reconciling them could prove difficult. Under pressure by moderate Democrats, the Senate jettisoned a key element of the House plan: a government-run insurance option. Many liberal Democrats believe they cannot declare a healthcare victory unless some sort of public insurance option is created.

Abortion will likely be another battleground issue between the House and Senate: Pro-life Democrats succeeded in inserting tough abortion restrictions in the House version while pro-abortion Democrats engineered a Senate compromise that is more lenient when it comes to taxpayer-funded abortions. And both differ on how to pay for the changes: The House relies on tax increases on the wealthy while the Senate taxes high-value insurance plans.

The Senate bill uses increased federal subsidies and the expansion of Medicaid to extend coverage to 31 million uninsured Americans. It increases taxes, cuts Medicare by nearly $500 billion, bars insurance companies from denying coverage for pre-existing conditions, and mandates that everyone has insurance or pay a penalty. It also would allow some middle income earners to get federal financial help, subsidizing insurance for a family of four making up to $88,000 annually.

Despite Senate Minority Leader Mitch McConnell's pleas this week that "one can stop it-or everyone will own it," healthcare opponents failed to get one Democrat to defect.

In fact, many wavering Democrats now head home for the holidays with stockings stuffed for their state: Senators from 11 states got significant sweeteners to join the Democrats' healthcare train.

Sen. Ben Nelson, D-Neb., who initially held out over taxpayer-funded abortion concerns, won his state a permanent exemption from paying its share of the costs associated with the expected increased Medicaid enrollment. Vermont, Massachusetts, and Nelson's Nebraska also got $1.2 billion in Medicaid assistance. Meanwhile Montana, North Dakota, South Dakota, Utah, and Wyoming enjoy higher federal reimbursement rates for doctors and hospitals serving Medicare patients. And in Florida, New York, and Pennsylvania, residents on the Medicare Advantage program will have their benefits protected while the program is cut elsewhere.

Democratic leaders this week shrugged off the behind-closed-doors deals as business as usual for the savvy members of Congress: "I don't know if there is a senator that doesn't have something in this bill that was important to them," Senate Majority Leader Harry Reid told reporters. "And if they don't have something in it important to them, then it doesn't speak well of them."