Image: Dem leaders
SAUL LOEB  /  AFP - Getty Images
American Medical Association President-elect Dr. Cecil Wilson, center, is joined by Democratic leaders to announce the AMA's endorsement of the Senate's health care reform legislation.
updated 12/21/2009 8:16:23 PM ET 2009-12-22T01:16:23

Well on the way to winning passage before Christmas after clearing its biggest hurdle in the wee hours of the morning, the Senate's health care bill will make a "tremendous difference for families, for seniors, for businesses and for the country as a whole," President Barack Obama said Monday.

Senate Democratic leaders basked in the victory for the landmark legislation that will insure 30 million more Americans. They looked ahead to the next make-or-break vote Tuesday morning. They snapped up a coveted endorsement from the American Medical Association and batted down Republican complaints about special deals lawmakers got in the bill.

"I don't know if there's a senator that doesn't have something in this bill that was important to them, and if they don't have something in it important to them, then it doesn't speak well of them," retorted Majority Leader Harry Reid, D-Nev., when questioned at a press conference about the GOP criticism.

The deals in the massive bill range from $100 million to pay the full cost of a Medicaid expansion in Nebraska, home to Democratic Sen. Ben Nelson, the crucial 60th vote for the bill, to exempting roughly 800,000 seniors in Florida from potential benefit cuts by private Medicare Advantage plans, something sought by Sen. Bill Nelson, D-Fla.

The American Medical Association got some special deals itself before declaring its support. 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, the AMA's president-elect, Dr. Cecil B. Wilson, said.

"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."

Democrats prevailed 60-40 over Republican opposition early Monday, voting to block a threatened GOP filibuster of a last-minute package of Democratic amendments.

Democrats will have to put up 60 votes again Tuesday morning for a procedural vote on Reid's underlying, 2,074-page bill. A last 60-vote hurdle awaits Wednesday, and final passage of the legislation — requiring a simple majority — is set for late Thursday, Christmas Eve, if Republicans take all the available time. As of Monday they said they would.

"I am willing to stay here. The flight that I have is Christmas morning, and I don't plan on changing that reservation," Sen. Bob Corker, R-Tenn., told reporters after a meeting of GOP senators. "We potentially are getting ready to pass a bill that there's no question in my mind is going to lead to huge deficits down the road."

With final passage on track, Republicans ramped up their criticism, denouncing the last-minute concessions that put the bill over the top.

"I am tired of the Congress thumbing their nose and flipping a bird to the American people," Republican National Committee Chairman Michael Steele said in a conference call with reporters.

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Reid promptly criticized Steele for saying "something so obscene" and "so crass and such a terrible example for the youth."

Sen. John McCain, R-Ariz., called the side deals "Bernie Madoff gimmicks," referring to the disgraced financier Bernard Madoff.

The deals that Nebraska and a few other states got on Medicaid prompted grumbling from some who got no special help.

"I think it is unfair," Gov. Arnold Schwarzenegger said in Sacramento, Calif. "Right now I don't feel we're getting our fair share of federal money in many different areas."

More criticism came from the activist watchdog Freedom Watch, which announced it was filing a federal court complaint against the Obama administration to force disclosure of details about meetings on health care between White House officials and industry lobbyists and executives.

Timeline: Health care highs and lowsThe 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 measures, 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.

But the bills have much in common. 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.

Each sets up new insurance marketplaces called exchanges where uninsured or self-employed people and small businesses can compare prices and plans designed to meet some basic requirements. Unpopular insurance practices such as denying people coverage based on pre-existing conditions would be banned.

Copyright 2009 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

Video: Health bill heads for Senate showdown

  1. Closed captioning of: Health bill heads for Senate showdown

    >> tonight.

    >>> though much of washington as we said was paralyzed by the storm, senate democrats still managed in the wee small hours of the morning to pass a key hurdle in the long fight over health care . our own kelly o'donnell joins us tonight from capitol hill with the shape of things to come. hey, kelly , good evening.

    >> reporter: good evening, brian . very little sleep, but plenty of friction here. because democrats were able to put together the required 60 votes. that is a big signal they can do it again for the final vote christmas eve . and everything has been a fight in trying to decide how much health insurance should change. after midnight, under bitter conditions, senators again arrived at the capitol, where bitter politics --

    >> there's no health care reform in this bill! there's health coverage expansion.

    >> reporter: -- pushed the key vote to 1:00 this morning.

    >> ms. stabenow, aye.

    >> reporter: and senate democrats unanimously stood behind the sweeping proposal.

    >> i can't emphasize enough how revolutionary it's going to be to transition from our surnt sick care system to a true health care system .

    >> reporter: changes that could affect you. what if i don't have health insurance ? everyone will be required to get coverage or pay a fine. if you can't afford it, you could apply for tax credits to help buy insurance. where to get coverage? if your job doesn't offer self-insurance or you're self-employed, you could shop for a policy choosing from a menu of private insurers much like federal employees do now, but that won't begin until 2014 . what would change right away? children with preexisting medical conditions cannot be denied coverage but for adults that starts in 2014 . for those with high medical bills, no more lifetime limits but cap benefits. what are the new taxes? if you earn more than $200,000 a year, your medicare payroll tax near doubles to .09%. and there's a brand new tax on tanning. th

    >> since i didn't get a chance to do this on the floor --

    >> reporter: feeling the heat from both parties, democrat ben nelson who held back his yes vote until he secured valuable extra money for his state, including a new hospital. majority leader harry reid defended that as compromise.

    >> we could go through this bill and talk about individual things for individual senators. we have a bill, we are happy with the bill we have.

    >> reporter: and they're happy enough, brian , that they will try to get the house to go along with essentially the same package. but that isn't easy, because the house still wants a government-run public option. and the senate has already abandoned that idea. brian .

    >> it could still get interesting between now and christmas eve . kelly o'donnell on the hill, thanks.

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