Senate Holds Vote on First Amendments to Health Care Bill

On Thursday during the third day of debate on its health reform bill (HR 3590), the Senate voted 42-58 to reject an amendment that would have stripped the bill of more than $400 billion in proposed Medicare cuts, Politico reports. The chamber also voted 61-39 to approve a proposal that would authorize the federal government to require health insurance plans to cover women's preventive health screenings (Budoff Brown, Politico, 12/3).

Medicare Amendment

Two Democrats -- Sens. Ben Nelson (Neb.) and Jim Webb (Va.) -- joined all 40 Republicans in voting for the Medicare amendment from Sen. John McCain (R-Ariz.), which would have sent the bill back to the Senate Finance Committee with an order to eliminate $446 billion in proposed Medicare cuts (Drucker, Roll Call, 12/3).

Approval of the amendment would have abolished one of the bill's key funding mechanisms (Politico, 12/3).

According to the Washington Post, the McCain amendment also would have forced Democrats to restart their efforts to extend coverage to 30 million additional uninsured U.S. residents without the risk of future budget deficits.

Democrats, with the support of AARP, said that the cuts are necessary to prolong the life of Medicare (Montgomery, Washington Post, 12/4).

Republicans argued that the cuts would hurt seniors.

Senate Minority Leader Mitch McConnell (R-Ky.) said, "I dare say that if you had asked seniors earlier this year what they expected health care reform would look like, it certainly wouldn't have involved massive cuts to a program that they've shown they like and they want" (Levey, Los Angeles Times, 12/4).

The Senate voted 100-0 to approve a compromise proposal by Sen. Michael Bennet (D-Colo.) stating that the legislation would not reduce the guaranteed Medicare benefits and that any savings would be redirected back into the program.

McCain said later, "I will eagerly look forward to hearing from the authors of this legislation as to how they can possibly achieve a half a trillion dollars in cuts without impacting existing Medicare programs negatively and eventually lead to rationing of health care in this country," adding, "That's what this motion is all about" (Ethridge [1], CQ Today, 12/3).

McCain also promised to continue pursuing the issue during the debate, while other Republicans vowed to offer new amendments similar to McCain's, according to Roll Call (Roll Call, 12/3).

Proposal To Improve Preventive Care for Women Advances

Meanwhile, the Senate voted 61-39 to approve an amendment to improve coverage and access to women's preventive health services, such as mammograms and annual screenings for cancer, without a copayment, CongressDaily reports (Edney, CongressDaily, 12/3).

The bipartisan proposal -- co-sponsored by Sens. Barbara Mikulski (D-Md.) and Olympia Snowe (R-Maine) -- would give the HHS secretary the authority to direct insurers to cover the cost of the preventive screenings and services for women.

The amendment would allow the HHS secretary to determine which screenings and services would be covered.

The Congressional Budget Office said the amendment would add $940 million to the 10-year cost of the reform bill, which CBO previously estimated would cost $848 billion over a decade (American Health Line, 12/2).

In addition to Snowe, Sen. David Vitter (R-La.) and Sen. Susan Collins (R-Maine) voted for the amendment.

Two Democrats -- Sens. Russ Feingold (Wis.) and Nelson -- voted against it. Feingold defended his vote, citing the lack of a proper funding plan for the amendment.

Nelson -- a vocal opponent of abortion rights -- said that the definition of preventive care should explicitly exclude abortion (Pear/Herszenhorn, New York Times, 12/4).

The amendment included a proposal by Vitter -- which the Senate accepted by unanimous consent -- that would bar the U.S. Preventive Services Task Force's recent recommendations on breast cancer screening from being used for coverage determinations (CongressDaily, 12/3).

Soon after approving the Mikulski-Snowe amendment, the Senate voted 41-59 to reject a more restrictive proposal by Sen. Lisa Murkowski (R-Alaska) that would have ordered the HHS secretary not to consider any recommendations or rankings offered by USPSTF in deciding to deny coverage (Ethridge [2], CQ Today, 12/3).

Murkowski's amendment also would have authorized insurers to use the recommendations of professional medical organizations (CongressDaily, 12/3). Nelson was the only Democrat to vote with Republicans in favor of the amendment.

Faced With Opposition Within Caucus, Reid Pledges To Press On

According to the New York Times, the votes on Thursday highlight the challenges that Senate Democrats face in trying to retain the support of one of its centrist members -- Nelson -- who voted with the Republicans in three out of the four amendments (New York Times, 12/4).

Senate Majority Leader Harry Reid (D-Nev.) has indicated that he will continue to press on, adding that he will file cloture to end debate on the bill "as soon as we work out all the problems with the legislation."