Final Votes in Congress Cap Battle on Health Care Bill

Published: March 25, 2010, New York Times

WASHINGTON — Congress on Thursday gave final approval to a package of changes to the Democrats’ sweeping health care overhaul, capping a bitter partisan battle over the most far-reaching social legislation in nearly half a century.

The bill, which Democratic leaders hailed as a landmark achievement, now goes to President Obama for his signature.

“The American people have waited for this moment for a century,” the Senate majority leader, Harry Reid of Nevada, said at a news conference. “This, of course, was a health bill. But it is also a jobs bill, an economic recovery bill, was a deficit-reduction bill, was an antidiscrimination bill. It was truly a bill of rights. And now it is the law of the land.”

In a fitting finale to the yearlong health care saga, the budget reconciliation measure that included the final changes was approved first by the Senate and then by the House on a tumultuous day at the Capitol, as lawmakers raced to complete their work ahead of a two-week recess.

The reconciliation bill makes numerous revisions to many of the central provisions in the measure adopted by the Senate on Dec. 24, including changes in the levels of subsidies that will help moderate-income Americans afford private insurance, as well as changes to the increase in the Medicare payroll tax that will take effect in 2013 and help pay for the legislation.

The bill also delays the start of a new tax on high-cost employer-sponsored insurance policies to 2018 and raises the thresholds at which policies are hit by the tax, reflecting a deal struck by the White House and organized labor leaders. It also includes changes to close the gap in Medicare prescription drug coverage known as the doughnut hole, and to clarify a provision requiring insurers to allow adult children to remain on their parents’ insurance policies until their 26th birthday.

Many of the changes were intended to address the concerns of House Democrats, as well as to bridge differences between the original House and Senate bills and to incorporate additional provisions sought by Mr. Obama.

The bill also included a broad restructuring of federal student loan programs, a centerpiece of Mr. Obama’s education agenda.

As the Senate voted, Mr. Obama was in Iowa City where he opened an aggressive public relations blitz to sell the health care overhaul with a campaign-style rally at the University of Iowa Field House.

Speaking to a crowd of about 3,000 Mr. Obama dared Republicans to follow through on their efforts to repeal the legislation, which would require them to win back big enough majorities in Congress to override his veto.

“My attitude is, go for it!” Mr. Obama declared, warning Republicans that he is eager to take them on this fall. “If these congressmen in Washington want to come here to Iowa and tell small-business owners that they plan to take away their tax credits and essentially raise their taxes, be my guest.”

It was in Iowa City that Mr. Obama first laid out detailed plans for “affordable, universal health care in America” as a presidential candidate in May 2007. When he delivered that speech, he was facing criticism for lacking substance; his proposal made policy analysts sit up and take notice.

“Because of you,” Mr. Obama told the crowd, “this is the place where change began.”

The Senate voted after running through an obstacle course of Republican amendments and procedural objections, which kept lawmakers working through Wednesday night until 3:30 a.m. Thursday.

Republicans, raising procedural challenges, identified small flaws that struck out two minor provisions. Those changes forced the bill to be sent back to the House one more time.

The Senate approved the measure shortly after 2 p.m. Senators cast their votes standing individually at their desks, a ceremonial gesture reserved for historic occasions.

Three Democrats opposed the measure, Senators Blanche Lincoln and Mark Pryor of Arkansas and Ben Nelson of Nebraska. Senator Johnny Isakson, Republican of Georgia, was ill and did not vote.

With both sides girding for a last round of parliamentary challenges, Vice President Joseph R. Biden Jr. arrived in the chamber to preside over the session in his role as president of the Senate. Mr. Biden served for 36 years as a senator from Delaware, making him intimately familiar with the chamber, its rules and precedents, and the main combatants on the floor.

As Senator Judd Gregg, Republican of New Hampshire, formally made the procedural challenges, Mr. Biden twice replied, “The point of order is sustained.” Then he added, “Both provisions are stricken.”

Once the roll call was completed, Mr. Biden declared, “The bill as amended is passed.”

The vote came after Senate Democrats defeated more than 40 Republican amendments intended to delay or derail the legislation, including proposals related to insurance coverage of erectile dysfunction drugs for convicted sex offenders, the legality of same-sex marriage in the District of Columbia, and gun rights.

The provisions struck out were minor. One sought to prevent any annual decrease in the maximum amount of Pell grants for students from low-income families; the other was technical.

Exuberant Democrats celebrated the vote in the corridors of the Capitol. Republicans, reacting somberly, said they would carry their opposition to the bill into the fall election campaign, in an effort to win back majorities in Congress and repeal the measure.

In a floor speech, the House Republican leader, Representative John A. Boehner of Ohio, derided the legislation as “a sloppy mess that the majority of the American people believe should be repealed and replaced.” He added, “We’re going to have to come back and fix this bill time and time again.”

Although the bulk of the Democrats’ overhaul was already the law of the land, the passage of the final revisions fulfilled a promise that Mr. Reid made to rank-and-file House Democrats before they took up the Senate version of the health care legislation and approved it Sunday night, 219 to 212.