Senate writing final chapter to health care bill

President Barack Obama has signed into law the most sweeping overhaul of U.S. health care since Medicare, but one last chapter in the epic struggle is still playing out in the Senate.

Senators are debating a package of fixes to the new health law, demanded by House Democrats as their price for passing the mammoth overhaul legislation that will extend coverage to 32 million uninsured Americans over the next decade. Obama signed the bill on Tuesday, declaring "a new season in America" as he sealed a victory denied to a line of presidents stretching back more than half a century.

The fix-it bill under consideration in the Senate eliminates a special Medicaid deal for Nebraska from the new law, softens a tax on insurance plans that was repugnant to organized labor, sweetens the pot with more expansive subsidies for lower-income people and offers more generous prescription drug coverage to seniors, among other changes.

Its approval at the end of this week is virtually assured, since it's being debated under fast-track budget rules that allow passage with a simple majority instead of the 60 votes usually required for action in the 100-seat Senate. Democrats control 59 Senate seats.

That didn't stop Republicans, who are unanimously opposed, from using the floor debate that began Tuesday afternoon as an opportunity to repeat the accusations they've lobbed at Obama's health legislation for the past year: that it raises taxes, slashes Medicare and includes a burdensome and constitutionally questionable requirement for nearly all Americans to carry health insurance.

The GOP came up with some new arguments too, including an amendment offered by Sen. Tom Coburn, R-Okla., that would prohibit sex offenders from getting Viagra prescriptions under federal health programs.

Sen. Dick Durbin, D-Ill., dismissed that as a "gotcha amendment" designed to be difficult for Democrats to oppose.

The main suspense surrounding this week's debate is whether the fix-it bill can emerge from the Senate unchanged. If it does, it can go straight to the president for his signature, since it's already passed the House. If the Senate changes it even in a minor way, the legislation would have to go back to the House to be passed again, a prospect House leaders are prepared for but say they don't expect.

If there are only minor changes the House would be almost certain to pass the bill again with little trouble, but if Republicans succeed in knocking out a significant provision or attaching a substantive amendment there could be difficulties in the House, where the legislation passed very narrowly Sunday night. Democratic leaders in the House and Senate say they have scrubbed the fix-it bill thoroughly to ensure that will not happen.

Republicans are introducing an array of politically sticky amendments such as Coburn's and another that would stipulate that Obama himself must get health coverage through a new purchasing exchange to be established under the health law. The GOP also is planning to raise points of order under rules requiring that provisions of the fix-it bill must have a budgetary impact. If Republicans argue that something doesn't and the Senate parliamentarian rules in their favor, the provision in question probably would be knocked out.

For Republicans, making it more difficult for Democrats to pass the fix-it bill is about the end of the road for congressional roadblocks against Obama's yearlong overhaul drive. But opponents already have launched a campaign from the outside, with 13 state attorneys general suing Tuesday to overturn the legislation on grounds it is unconstitutional.

And Senate Minority Leader Mitch McConnell, R-Ky., served notice Tuesday of the GOP's continued campaign against the legislation going into the fall election season. "The slogan will be 'repeal and replace,' 'repeal and replace,'" McConnell said.

Obama planned to sign an executive order Wednesday affirming existing law against federal funding of abortions, except in cases of rape, incest or danger to the woman's life. A critical bloc of anti-abortion Democrats in the House had pledged to vote against the health care package unless given greater assurances that it would not amend current law.

In a last-minute deal, Obama agreed to issue the order to get their votes.