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Health Care Reform Survives Final Vote

The Congressional Democratic push to overhaul health care is finally, at very long last, done.

House Democrats voted 220-207 Thursday night to approve a package of fixes to the underlying law after the Senate made two minor changes to the version the House first passed on Sunday night. Thirty-two Democrats voted “no.” The reconciliation package now heads to President Barack Obama for his signature.

The package makes a number of changes to the Senate-authored health care overhaul demanded by House Democrats. It dramatically scales back and delays until 2018 a tax on high-cost “Cadillac” insurance plans, strikes some special deals cut with individual Senators, boosts affordability credits, and adds a revamp of the student-loan industry.

It first cleared the House on Sunday night, but the Senate was unable to approve the bill unchanged after Republicans found two minor provisions that the Parliamentarian agreed should be stricken because they were in violation of strict budget reconciliation rules. The final Senate vote Thursday for passage, 56-43, was more than the commitments Senate Majority Leader Harry Reid (D-Nev.) told Pelosi he had, noted Sen. Charles Schumer (N.Y.), the No. 3 Democrat in the chamber.

Sens. Blanche Lincoln (D-Ark.), Mark Pryor (D-Ark.) and Ben Nelson (D-Neb.) voted with all Republicans against the bill, despite having been part of the filibuster-proof 60-vote majority that pushed the Senate bill to passage on Christmas Eve 2009. Lincoln, for example, said she did not believe the reconciliation process — which by law cannot be filibustered — was the right way to make changes to the Senate bill that Obama signed into law Tuesday.

Though they couldn’t live up to their promise to pass reconciliation intact, Senate Democrats did beat back 42 GOP amendments to the reconciliation package in a two-day vote-a-rama. Even after it became clear that Republicans would be able to strike 16 lines of text from the bill, Democrats continued to vote down politically sensitive amendments, including a proposal by Sen. Tom Coburn (R-Okla.) that would have barred insurance coverage of erectile dysfunction drugs for sex offenders. Democrats fear votes against proposals like Coburn’s could be turned into an effective campaign attack ad come November.

Sen. Benjamin Cardin (D-Md.) said Democrats were largely committed to keeping the reconciliation bill free of other amendments because of the House’s leap of faith in passing the Senate health care bill.

“I think that most Democrats agree that this is basically a conference report that was well-negotiated between the House and the Senate and that it’s not up to the Senate at this point to make changes in the bill,” Cardin said.

Democrats were not united on all amendment votes, but their 59-member Conference was large enough to let some Members vote with Republicans while still killing most of the GOP attempts to amend the bill.

Nelson and Lincoln voted the most often against the majority of their party.

Lincoln is one of the most endangered Senate Democratic incumbents this year, while Nelson had previously announced his opposition to the inclusion of provisions eliminating government subsidies to banks that offer student loans. Nelson indicated that his decision to vote with the Republicans on most amendments was related to his opposition to the bill. Nelson joked about his decision to vote with the minority on several of their amendments, all of which failed, saying: “Maybe they voted with me.”

Despite their ability to find two small provisions to strike, Republicans gave grudging respect to Democrats for their efforts to prevent the bill from falling victim to points of order. “They did a pretty good job of scrubbing the reconciliation bill,” Sen. Richard Burr (R-N.C.) said Wednesday afternoon.

Senate Budget Chairman Kent Conrad (D-N.D.) also seemed to compliment Republicans for their tenacity in looking for points of order that would force the House to revote.

For example, Republicans successfully challenged language in the bill that would make the reconciliation law conform with other laws — routine language for almost all legislation.

“It is such a nothing that nobody thought would be an issue,” Conrad said. “That’s just not typically something that would be any kind of a flag.”

Conrad said he told Republican leaders early Thursday morning, “I could have spent two years going over that bill. I would have never thought that was” a violation of budget reconciliation rules.

The other provision that was struck from the bill dealt with formulas for the maximum Pell Grant award, but Conrad said the issue was minor enough that the committees of jurisdiction could wait until the next Congress to deal with the issue.

Successful budget points of order have the effect of striking offending language from the bill, thereby amending it. Sixty votes — one more than the Senate Democratic Conference has — are needed to retain such provisions.

David M. Drucker contributed to this report.

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