Senate OKs health-care measure, reaching milestone

WASHINGTON — The Senate's vote early Thursday to overhaul the nation's health-care system moves the nation closer than it has ever been to a dramatic change in how Americans get medical care.

"We may not completely cure this crisis today or tomorrow," said Senate Majority Leader Harry Reid, D-Nev., "but we must start toward that end."

At the White House, President Obama said, "With today's vote, we are now incredibly close to making health-insurance reform a reality in this country. These are not small reforms. These are big reforms."

Despite all the compromises — and more to come as the Senate and House try to reconcile their versions of the legislation — Obama put a positive spin on the effort. If the changes become law, he said, they would be the biggest social change since the creation of Social Security in the 1930s.

Fifty-eight Democrats (including Washington Sens. Patty Murray and Maria Cantwell) and two independents — but none of the Senate's 40 Republicans — voted for the $871 billion bill, which would require most Americans to obtain health insurance, provide federal aid for those who have difficulty paying for coverage and bar insurers from denying policies to people with pre-existing conditions.

The scene at the Capitol on Thursday was historic and at times surreal, as lawmakers arrived on a dark, icy, 26-degree morning. Reid and Senate Republican leader Mitch McConnell of Kentucky made brief remarks, and at 7 a.m. sharp, senators took the unusual step of voting from their desks. The bill passed 60-39 at 7:15 a.m., about 10 minutes before sunrise. (Sen. Jim Bunning, R-Ky., was absent and did not vote.)

As Vicki Kennedy, widow of Massachusetts Democratic Sen. Edward Kennedy, who spent much of his legislative life pushing for health-care change until he died in August, watched from a balcony gallery, Sen. Robert Byrd, D-W.Va., the 92-year-old dean of the Senate, cast his vote by gently saying, "This is for my friend Ted Kennedy."

Obama called Kennedy's widow and a dozen Democratic senators, but no Republicans, according to White House officials. He also called David Turner, an Arkansas man with insurance woes who sat with first lady Michelle Obama when the president addressed a joint session of Congress this year.

It was a bitter moment, though, for the Republican Party, whose efforts to delay the vote resulted in the Senate's first Christmas Eve vote since 1895. Even at the end, McConnell was unrelenting in his opposition.

"This debate was supposed to produce a bill that reformed health care in America," he said in his closing argument. "Instead, we're left with party-line votes in the middle of the night."

Lawmakers and interest groups now will begin scrambling to influence one of Congress' most mysterious but most powerful institutions: the conference committee, consisting of a handful of senior lawmakers loyal to party leaders.

To most Americans, the conference process is an enigma, rarely taught in history or civics lessons. On Capitol Hill, however, it's a tradition steeped in late-night, closed-door deals and howls of protest from the frozen-out minority party.

"Probably the best part of the sausage-making process is the least understood and the most important," former House Budget Committee Chairman Jim Nussle said.

Nussle, an Iowa Republican and former director of the White House Office of Management and Budget, said it isn't unusual for a chairman to call one official, open a conference meeting with all Democratic and Republican appointees present and then quickly adjourn.

The conference then usually goes behind closed doors, often without telling the minority conferees — in this case, Republicans — when or where the meetings are being held, Nussle said.

While health-care committee members haven't been named, it's widely expected to include Sen. Chris Dodd, D-Conn., one of the Senate bill's architects, and: Reid; Senate committee chairmen Max Baucus, D-Mont., and Tom Harkin, D-Iowa; and House committee chairmen Charles Rangel of New York, and George Miller and Henry Waxman of California, according to Harkin.

The Senate version is likely to dominate, because the conference needs the support of party moderates to get the 60 Senate votes it will need to overcome procedural hurdles.

"Anybody who understands this process knows how hard it is to get 60 votes," said Sen. Kent Conrad, D-N.D., chairman of the Budget Committee. "So it's clear the bill will need to be close to the Senate version."

Former Connecticut Rep. Barbara Kennelly, now president of the National Committee to Preserve Social Security and Medicare, agreed.

"The Senate has taken the House hostage. That's all there is to it," she said. "Do we have health-care reform in the bill the way we like it? No. I have to be for the bill because it's a starting point."

While administration officials aren't part of the health-care conference, Chief of Staff Rahm Emanuel, health-care expert Nancy Ann Deparle and others are expected to be in close touch.

"Every conference I've been on for 30-plus years has had White House involvement," Harkin said.

The internal dynamics of a conference can be reminiscent of Reginald Rose's "12 Angry Men," a play about tension in a deadlocked jury, where stamina, personality, ego and stubbornness can play major roles, former Nebraska Democratic Sen. Bob Kerrey said.

"People like myself, who have run for office before, we have 25 percent more capacity for self-delusion than most people," said Kerrey, now president of the New School in New York. "In conference, it comes down to, 'If they get to know me, they'll support me.' "