WASHINGTON — Unflinching on a critical first test, Senate Democrats closed ranks Thursday behind $460 billion in politically risky Medicare cuts at the heart of health care legislation, thwarting a Republican attempt to doom President Barack Obama's sweeping overhaul.
The bid by the bill's critics to reverse cuts to the popular Medicare program failed on a vote of 58-42, drawing the support of two Democratic defectors. Approval would have stripped out money needed to pay for expanding coverage to tens of millions of uninsured Americans.
The broader legislation aims to extend health coverage to 31 million who now lack it, while barring insurance industry practices such as denying coverage on the basis of pre-existing medical conditions. Though the overhaul is estimated to cost about $1 trillion over a decade, the Congressional Budget Office has said it would cut federal deficits by $130 billion over that period, and probably reduce them further in the 10 years beyond that.
"Our bill does nothing to reduce guaranteed Medicare benefits," said Sen. Max Baucus, D-Mont., as several fellow Democrats accused Republican critics of making false claims of potential harm during three days of debate.
The AARP supported the 10-year package of cuts in projected spending, giving Democrats political cover for their decision to pare back subsidies to private Medicare plans as well as payments to hospitals, hospices, home health agencies and other providers.
Republicans disagreed vigorously. "Medicare is already in trouble. The program needs to be fixed, not raided to create another new government program," said the party's leader, Sen. Mitch McConnell of Kentucky.
Video: Battling over Medicare cuts The Medicare vote came not long after the Senate backed a guarantee for all insured women age 40 and older to receive mammograms with no out-of-pocket costs. The breast cancer screening test would be included in an array of preventive measures that insurance plans would be required to cover. The proposal cleared on a near party-line vote of 61-39, one more than the 60 needed for passage. It essentially wiped out a federal advisory committee recommendation to defer routine mammograms until women reach the age of 50.
The day's votes were the first since the Senate's health care debate began on Monday, and demonstrated the ability of Democrats to move ahead in the face of implacable Republican opposition.
At the same time, Democrats worked in private meetings to settle controversies within the party that are still standing in the way of the bill's passage. The most contentious of these involves proposals for the government to sell insurance in competition with private companies, an approach supported by liberals but opposed by most Democratic moderates and conservatives.
"Our caucus is now in the process of negotiating with ourselves because we need all 60 of us to get this done," said Sen. Mary Landrieu, D-La., after one closed-door meeting. Senate procedures require 60 votes to overcome Republican delaying tactics designed to kill the bill.
Majority Leader Harry Reid, D-Nev., said he expected all such issues to be worked out soon, but he did not specify precisely when.
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Video: Hatch: 'Stupid' job expectations from Dems For the time being, that left the two parties free to engage in an intensely political debate on health care, an issue that is certain to play a role in next year's midterm elections.
Unwilling to allow Republican charges on Medicare to go unanswered, Democrats responded with an alternative that stated no guaranteed benefits would be cut from the program and its finances would be strengthened.
The lead proponent of that provision was Sen. Michael Bennet of Colorado, who was appointed to his seat earlier in the year and faces a difficult campaign in 2010. "This is a message amendment," his office informed fellow Democrats in an e-mail unintended for publication, indicating its purpose was political. "The Senate bill already does these things and this amendment makes these facts absolutely clear and succinct." It passed 100-0.
Sen. John McCain of Arizona, Obama's Republican opponent in last year's presidential race, laid bare the political nature of the debate by making a recording to be telephoned automatically to thousands of voters in states represented by Democrats, urging the deletion of the Medicare cuts. The calls were paid for by the National Republican Senatorial Committee and took aim at Bennet as well as Sens. Blanche Lincoln of Arkansas, who is seeking a new term next year, and Ben Nelson of Nebraska.
In the end, Nelson and Sen. Jim Webb of Virginia were the only Democrats to support McCain's proposal.
On the other side, Republicans would not allow the Democrats to go unchallenged on women's health with a proposal long backed by Sen. Barbara Mikulski requiring the government to develop a list of tests to be covered at no additional cost to the patient.
On Wednesday, Sen. David Vitter, R-La., made it explicit that mammograms would be covered for women at age 40.
More broadly, Sen. Lisa Murkowski, R-Alaska, backed an alternative that gave GOP senators opposed to the Democratic proposal a measure they could support. It urged the insurance industry to consult with medical experts in deciding what preventive tests to provide. But it provided no government guarantee that any would be required, and did not rule out co-pays for patients undergoing the procedures.
Who's who in the health care debateIt failed on a vote of 59-41 with Nelson siding with the Republicans.
Political philosophy played a hidden role in the struggle over women's health. Republicans have accused Democrats for months of supporting a federal takeover of health care. Murkowski quietly shelved an earlier draft of her amendment that would have given the government authority to require additional preventive tests and raised the cost of the bill by $30 billion over a decade. One Republican said conservatives objected, forcing the switch.
Overall, the $1 trillion legislation would require most Americans to purchase insurance and provide federal subsidies to lower and middle income individuals and families to defray the cost. Businesses would not be required to provide coverage to their employees, but large firms would face a penalty if they did not and if any of their workers received federal subsidies.
Consumers would be allowed to shop for insurance in a new marketplace in which companies would compete for business by selling policies that provide benefits according to standards established by the federal government.
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