Senate Passes Health Care Reform Bill Before Holiday Recess

The vote was scheduled for the morning of December 24, and it took place before most Americans were awake. Senators spent this morning in chambers—the first time in over 40 years they had labored on Christmas eve—to pass healthcare reform in a vote of 60-39, just in time for the members of Congress to spend the holidays with family.

The long, elaborate, and sometimes painful and confusing process of America’s health care reform started with the campaign of then-presidential candidate Barack Obama promising efforts toward the passage of universal health care, moved to President Obama’s push for the Senate to work toward substantial reforms, and bills introduced to the House and Senate in late October of 2009. House Speaker Nancy Pelosi was able to pass the Affordable Health Care for America Act (H.R. 3962) on November 7 by a narrow margin of 220-215. By November 30, the Senate moved forward with its bill and began the debate and negotiation process.

In order to achieve unanimous support of all 60 Democrats, as the entirety of the Republican Senate made it clear that they would collectively oppose the bill, concessions began to deplete the bill of its public option, the idea of an extended Medicare buy-in option rose and fell, and one Democrat—Senator Ben Nelson—had to be bribed with free Medicare to his home state of Nebraska from 2016 going forward in order to vote with his party despite his insistence upon adding tighter abortion restrictions to the reform bill that weren’t satisfied. And along the way, the Senate bill came to include a mandate that the American public purchase health care from existing insurance companies, with limited subsidies and a thin hardship exemption to assist those not able to comply. Every addition and subtraction from the bill was examined closely by each Democrat, and eventually it they all appeared to be prepared to support it, despite its $871 billion price tag and the far-away objections being heard by House Democrats who have to reapprove the legislation.

The wee hours of the morning on the weekend before Christmas found the Senate voting to end the debate on the bill, and the 60-40 vote, directly down party lines, served its purpose. And the passage was enough to give Senators a day off before returning to the floo  to finalize the legislation before the vote to move the bill forward. And it was at approximately 7:00am on December 24 that the Senate met to hold its vote on the final bill, and the Democrats received the outcome they desired as the bill passed by a vote of 60-39, again directly down party lines. The missing vote was Republican Jim Bunning, who opposed the bill and chose not to participate in the final vote.

The groundbreaking legislation in its final Senate form contained provisions that intended to cover 30 million Americans who are currently uninsured. While Americans will be forced to purchase a health insurance policy, federal subsidies will be available for families with incomes at or under 400 percent of the federal poverty level, which equals approximately $88,000. Medicaid will be expanded to Americans earning up to 133 percent of the poverty level, or $29,000 for a family of four. Small businesses will be given a boost to their ability to buy insurance with access to an insurance exchange that will allow the companies to pool resources to achieve more reasonable pricing on insurance plans for employees. Insurance companies will meet with some restrictions, including a ban on denying insurance coverage to those with preexisting condition or charging higher premiums per gender or medical history, though age-based price increases will still be allowed. Finally, the bill will also limit out-of-pocket expenses for customers.