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Sunrise Votes Nudge Health Care Bill Forward Tuesday in Senate

December 22, 2009

WASHINGTON (AP) - Two down, one to go. President Barack Obama's health care overhaul cleared its second 60-vote test in the Senate early Tuesday morning - moving it a step closer to passage by
Christmas.

Senate Democrats remained united behind their compromise bill,
over steadfast Republican opposition. The motion, to shut off
debate and move to a vote on a package of changes by Senate
Majority Leader Harry Reid, passed 60-39.

The final 60-vote hurdle, limiting debate on the bill itself, is
expected Wednesday afternoon. That would start a 30-hour countdown to a night-before-Christmas vote on the legislation, which needs only a simple majority to pass.

The Senate has been voting at odd hours since Monday around 1
a.m., because Republicans have insisted on using all the time
allowed them under Senate rules to delay the bill. Not to be
thwarted, Reid, D-Nev., has refused to postpone action until after
the holidays. Hence the unusual schedule. On Tuesday, they started
voting at sunrise.

With long hours getting in the way of family obligations - and
the outcome now seemingly preordained - senators are getting
frustrated. Even Obama has put his planned vacation to Hawaii on
hold, saying he wants to be in Washington in case there are
last-minute problems in the Senate.

Reid appealed to his colleagues Tuesday to set aside acrimony
and reach for some holiday spirit. "I would hope everybody will
keep in mind that this is a time when we reflect on peace and good
things," he said. If Republicans agree, the schedule of votes
could be shortened and senators would go home earlier.

There was still no sign partisan fires had cooled.

GOP Sen. Lindsey Graham of South Carolina denounced concessions
won by conservative Nebraska Democratic Sen. Ben Nelson, whose
support gave Democrats the 60th and final vote they need. Among
other things, Nelson got an agreement that the federal government
will pay to expand Medicaid services in Nebraska.

Said Graham: "That's not change you can believe in. That's
sleazy." He was interviewed on NBC's "Today" show.

Democratic Sen. Tom Harkin of Iowa defended the concessions,
saying: "The one that's being talked about for Nebraska, it also
benefits other states. It's not just Nebraska."

He also said he would vote for the package even if it didn't
contain concessions for Iowa. "The principle of this bill
overrides everything," Harkin told CBS' "Early Show."

Moderate Sen. Mary Landrieu, D-La., who has also been criticized
after securing a boost in Medicaid for her state, defended the
concessions she got, saying they benefited low-income families
small businesses.

The Senate measure would still have to be harmonized with the
health care bill passed by the House in November before final
legislation would go to Obama.

There are significant differences between the two bills,
including stricter abortion language in the House bill, a new
government-run insurance plan in the House bill that's missing from
the Senate version, and a tax on high-value insurance plans
embraced by the Senate but strongly opposed by many House
Democrats.

Senate moderates have served notice they won't support a final
deal if government-run insurance comes back. And Democratic
abortion opponents in the House say a Senate compromise on the
volatile issue is unacceptable.

But there's considerable pressure on Democrats to avoid messy
negotiations over a final bill. Public support for the legislation
continues to sink in opinion polls, even as the Senate advances.

The bills probably have more in common than differences. Each
costs around $1 trillion over 10 years and installs new
requirements for nearly all Americans to buy insurance, providing
subsidies to help lower-income people do so. They're paid for by a
combination of tax and fee increases and cuts in projected Medicare
spending.

Unpopular insurance company practices such as denying coverage
to people with existing health conditions would be banned.
Uninsured or self-employed Americans would have a new way to buy
health insurance, via marketplaces called exchanges where private
insurers would sell health plans required to meet certain minimum
standards.

The American Medical Association announced its endorsement of
the Senate bill Monday after Reid made some last-minute changes to
please the doctors. A 5 percent tax on elective cosmetic surgery
procedures was replaced with a 10 percent tax on indoor tanning
services; a proposed fee on physicians to enroll in Medicare was
dropped; and payment cuts to specialty and other physicians to pay
for bonuses to primary care doctors in underserved areas were also
eliminated, said the AMA's president-elect, Dr. Cecil B. Wilson.

"America has the best health care in the world - if you can get
it," Wilson said at a press conference with Reid and other
leaders. "For far too many people access to care is out of reach
because they lack insurance. This is not acceptable to
physicians."


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