Republicans forced Democrats to vote in favor of cutting billions from providers of home care for older people as partisan debate flared Saturday during a rare weekend session on President Barack Obama's health care overhaul.
Obama planned to travel to Capitol Hill on Sunday to help Democrats resolve internal disputes that stand in the way of Majority Leader Harry Reid bringing the 10-year, nearly $1 trillion legislation to a vote.
Ahead of his visit, Republicans, bent on making Democrats cast politically risky votes, offered their third amendment in the debate so far showcasing more than $400 billion in cuts to projected Medicare spending that would pay for the bill, mostly for subsidies to help extend coverage to millions of uninsured.
Like the other two, this one went down to defeat, on a vote of 53 to 41. The measure by Sen. Mike Johanns, R-Neb., would have eliminated $42 billion in cuts over 10 years to agencies that provide home health care to seniors under Medicare.
Four moderate Democrats joined all Republicans present in voting for the amendment: Sens. Jim Webb of Virginia, Evan Bayh of Indiana, Blanche Lincoln of Arkansas and Ben Nelson of Nebraska.
Underscoring the pressures on the moderates, Lincoln, who faces a difficult re-election next year, initially cast a "no" vote with the Democratic majority but switched to "yes" in the course of the 15-minute vote. Republicans accused her of flip-flopping, but Lincoln said later that she changed her vote after considering how important home health care is to Arkansas.
"That's why they give us 15 minutes," said Lincoln.
The more consequential action was taking place behind closed doors Saturday as Democrats struggled to find a compromise on a proposed government insurance plan that would compete with private insurers. Lincoln and several other moderate Democrats are opposed to the government insurance plan in the bill, and Reid, D-Nev., doesn't have a vote to spare in his 60-member caucus.
Health and Human Services Secretary Kathleen Sebelius joined in some discussions and several senators cited progress on the issue. There was discussion of various options, including nonprofit insurance plans administered by the Office of Personnel Management, which runs the Federal Employees Health Benefits Program.
"I'm optimistic that something, I'm not sure what, but something can be arrived at," said Sen. Mary Landrieu, D-La. "It's definitely going to be something that's of a nonprofit nature."
Reid called the unusual sessions as he races to finish the bill by Christmas. The weekend work also allowed him and other Democrats to highlight their commitment to Obama's signature issue, arguing that Americans can't take weekends off from worrying about health care, so the Senate shouldn't, either.
Republicans, determined to stall if they can't kill the bill, weren't impressed.
"I think the majority leader believes that somehow if we stay in on weekends the Republicans are going to blink. I assure him we're not going to blink," said Senate Minority Leader Mitch McConnell, R-Ky.
Lawmakers went at each other over who really wanted to protect older people.
Johanns said home health care agencies were being unfairly targeted in the legislation, noting that they account for 3.7 percent of the Medicare budget but would absorb 9.4 percent of the cuts to Medicare in the Senate bill. The percentage is even higher in the House version of the legislation, which passed last month.
"These are truly some of the most vulnerable Americans that receive these services and the cuts are placed directly on their backs," Johanns said.
Proposed cuts defended
Democrats said those cuts, and others to Medicare private insurance plans and providers, would reduce overpayments, inefficiency and waste in the popular program, thereby strengthening it. They noted repeatedly that AARP supports the overall cuts, and also produced a letter from the National Association for Home Care and Hospice in support.
The Dec. 4 letter said the group has "agreed to do its part by reducing costs and payments in a manner that makes the Medicare home care program more efficient and less susceptible to abuse."
But Democrats didn't want to let the Republican amendment go unanswered, so Sen. John Kerry, D-Mass., offered an amendment stating that the bill would not reduce guaranteed home health benefits. It passed 96-0.
"They're busy talking about the cuts when this actually improves what Medicare beneficiaries are going to get," said Kerry, referring to new preventive services and other items in the bill.
MEDPAC, an organization established by Congress to advise lawmakers on Medicare, has projected that home health care agencies would be overpaid by Medicare in 2009 by margins of 12.2 percent overall. There are some 9,700 companies providing home health care under Medicare.
The overhaul legislation would provide coverage to more than 30 million more people over the next decade with a new requirement for nearly everyone to purchase insurance. There would be new marketplaces, lower-income people would get subsidies, the federal-state Medicaid program for the poor would grow, and there would be a ban on unpopular insurance company practices such as pulling coverage when someone gets sick.
Saturday was the sixth day of debate on the legislation.