This afternoon, in a vote of 56–43, the Senate passed a package of fixes amending the bill President Obama signed into law on Tuesday. The reconciliation package now goes back to the House for a second vote later tonight, after Senate Republicans succeeded in slightly changing several technical provisions. In fact, a GOP aide acknowledged to Roll Call that the changes are largely inconsequential,” and admitted that Republicans were trying to force Democrats to cast “dozens of difficult votes.” The aide indicated that Minority Leader Mitch McConnell (R-KY) had been confident the parliamentarian “would rule in his favor throughout the vote-a-rama and kept the points of order in his back pocket until late in the evening to ensure Democrats made tough political votes.”
Indeed, during the more than 20 hours of debate, conservative senators proposed a myriad amendments designed to sink the package, some of them not even germane to the actual bill. Sen. David Vitter (R-LA), in a throwback to an earlier effort that was ruled unconstitutional, introduced an amendment that would bar all federal funding for ACORN, which is already set to dissolve due to lack of funds. Sen. Tom Coburn (R-OK) proposed an amendment to deny erectile dysfunction drugs to sex offenders. Sen. Bob Bennett (R-UT) introduced an amendment that would require a public referendum in Washington, DC on same-sex marriage even though the DC government put it into law.
These distractions, however, shouldn’t take away from the importance of the accomplishment. While these fixes pale in comparison to the historic nature of the underlining Senate bill, the package of amendments — collectively known as the Reconciliation Act of 2010 — will make insurance more affordable for middle class families, completely close the Medicare Part D doughnut hole for seniors, strengthen the employer responsibility provisions, and move up the implementation date on the excise tax. It may not be everything progressives had hoped for, but it only strengthens the foundation for future reforms.
And of course, much remains to be done. Majority Leader Harry Reid (D-NV) has promised to hold a vote on the public health care option as a stand alone measure and there could be some interest in implementing Sen. Dianne Fienstein’s (D-CA) national rate review authority to prevent insurers from jacking up rates between now and when the exchanges become operational. Moreover, Congress is going to have to tackle the Sustainable Growth Rate formula (aka doc fix) before the next round of cuts on October 1st and will likely introduce legislation to increase Medicaid reimbursement rates to Medicare levels beyond 2014, to ensure that the newly insured enrolled population has adequate access to doctors.
Lawmakers will have to tweak reform in years to come, but for the millions of Americans without coverage and for those struggling to afford their premiums, things will begin to finally change.
Moments ago, the House passed the reconciliation package by a vote of 220 to 207.