Health Reform Scorecard

The Senate passes health reform.

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Carl Levin and John McCain

The health care reform bill passed the Senate on Dec. 24, 60-39 (Sen. Jim Bunning, R-Ky., didn’t vote). Slate kept a cumulative daily scorecard of amendments, presented here with sponsors’ names, plain-English descriptions, links to texts and summaries, and roll call votes, with the most recent at the top. The bill now goes to House-Senate conference. The conference report will be voted on in the House and Senate in January, or possibly February.


  • Senate Majority Leader Harry Reid’s cloture motion on the health care reform bill. Passed Dec. 23, 60-39. (Sen. Jim Bunning, R-Ky, didn’t vote.)
  • Senate Majority Leader Harry Reid’s cloture motion on the “substitute” (i.e., the bill plus Reid’s manager’s amendment; see 3276, below). Passed Dec. 22, 60-39 (Sen. James Inhofe, R-Okla., didn’t vote).
  • Senate Majority Leader Harry Reid’s amendment (3278) to “tear down the amendment tree,” clearing a path to a vote on his manager’s amendment (see 3276, below). An “amendment tree” is a series of placeholder amendments that the majority leader may add to a bill to prevent its being amended further. In this instance, the amendments, which were added Dec. 19,  alteredan enactment date in the bill by four days (3278), then three (3279), then two (3280), then one (3281), then none (3282). Passed, Dec. 22, 60-39 (Sen. James Inhofe, R-Okla., didn’t vote).
  • Senate Majority Leader Harry Reid’s “manager’s amendment” (3276), which won support for the bill from Democratic Sen. Ben Nelson the last holdout within the 60-member Democratic caucus ( text). This clears the way to final passage. The amendment removes the public option and allows state legislatures to prohibit abortion coverage within their individual health insurance exchanges. In essence, this is the same state “opt out” mechanism that Reid tried and failed to sell as a compromise on the public option. The Congressional Budget Office ( analysis; blog summary) estimates that Reid’s amendment would add $2 billion in budget savings to the $130 billion it earlier projected over a 10-year period. (That estimate does not take into account the cost of other amendments, listed below, that were added to the bill.) Passed cloture vote Dec. 21, 60-40. Click here to watch the vote on video. The amendment itself passed Dec. 22, 60-39 (Sen. James Inhofe, R-Okla., didn’t vote).
  • Republican Sen. Kay Bailey Hutchison’s motion to delay taxes used to pay for the bill until the bill is actually implemented ( text, floor statement). Set aside Dec. 16, 56-41.
  • Democratic Sen. Bernie Sanders’ amendment (2837) establishing a single-payer health system ( text, summary, press statement). Withdrawn Dec. 16 after Republican Sen. Tom Coburn refused to dispense with the reading of the amendment, which is 767 pages long. Click here to watch a clip of Sanders’s amendment being read on the Senate floor before Sanders threw in the towel. Click here to watch an Aug. 24 clip of Sen. Coburn (a medical doctor!) telling the wife of a man with a traumatic brain injury to suck it up: “The idea that the government is a solution to our problems is an inaccurate, a very inaccurate statement.”
  • Republican Sen. Mike Crapo’s motion to strip the bill of any provisions that will result in a tax increase for individuals earning less than $200,000 or families earning less than $250,000 ( text, floor statement). The obvious point of this amendment was to embarrass President Obama for violating his promise that health care wouldn’t impose taxes on this group (which, for the most part, it won’t). Failed Dec. 15, 45-54.
  • Democratic Sen. Max Baucus’ amendment (3183) declaring that, contrary to Sen. Crapo’s motion, health reform doesn’t raise taxes on the middle class, it lowers them (through tax credits for the purchase of health insurance by businesses and individuals), so there ( text, floor speech). Did somebody really call this the world’s greatest deliberative body? Passed Dec. 15, 97-1.
  • Democratic Sen. Byron Dorgan’s amendment (2793) allowing the importation of drugs approved by the Food and Drug Administration ( text, press statement). This is a popular consumer cause, favored as a cost-saving measure by Sen. John McCain, among others. But Margaret Hamburg, President Obama’s commissioner of the Food and Drug Administration, opposes it on safety and other grounds. Hamburg’s opposition is embarrassing for Obama because he supported this reform during the 2008 campaign and, as a senator, co-sponsored Dorgan’s bill. But in July the Obama White House struck a bargain with the pharmaceutical industry to limit the bill’s cost to drug companies to $80 billion and to block certain measures, including the reimportation of drugs. (Whether this last promise was explicit is unclear; drug industry lobbyist Billy Tauzin told the Los Angeles Times that it was, but the L.A. Times subsequently suggested it was merely implied. Still later, the Wall Street Journal’sAlicia Mundy, paraphrasing “several industry lobbyists and congressional staffers,” called it a “private promise.”) In exchange, Big Pharma gave its support to health reform. It was a bad deal. Failed Dec. 15, 51-48. (This amendment required 60 votes to pass.)
  • Democratic Sen. Frank Lautenberg’s amendment (3156) ( text, floor speech) proposing an alternative to the Dorgan amendment that requires prior approval for drug importation from the health and human services secretary, which probably wouldn’t be granted. Failed Dec. 15, 56-43. (This amendment required 60 votes to pass.)
  • Republican Sen. John McCain’s motion ( text, floor statement) to send the bill back to the finance committee so it can extend to all Medicare Advantage beneficiaries the special deal Democratic Sen. Bill Nelson won for his Florida constituents. Score one for McCain: This amendment (which will not pass) shines a spotlight on a cheesy political bargain. Nelson, after trying unsuccessfully in the finance committee to “grandfather” (i.e., maintain for existing beneficiaries) benefit levels for all current Medicare Advantage recipients, got a narrower provision inserted providing relief to Medicare Advantage recipients living in certain “ local areas” as determined by a complex formula that fits South Florida like a glove. McCain is in effect saying: Hey pal, share the wealth! Can you blame him? The motion failed Dec. 8, 42-57.
  • Democratic Sen. Ben Nelson’s amendment (2962), modeled on Democratic Rep. Bart Stupak’s amendment to the House bill, effectively barring health insurers from selling policies through the exchange that cover abortion ( press statement, text). Set aside Dec. 8, 54-45.
  • Republican Sen. Judd Gregg’s amendment (2942) ( text, press statement) requiring Medicare savings to be used to “save Medicare.” Gregg is the author of a Dec. 1 letter to fellow Republicans offering parliamentary tips on how to obstruct health reform. So don’t waste too much attention on this. Failed Dec. 7, 43-56.
  • Democratic Sen. Mark Pryor’s amendment (2939) ( text, press statement) requiring the Health and Human Services secretary to collect through an Internet portal information about enrollee satisfaction with health plans offered through the proposed insurance exchange. Passed Dec. 7, 98-0.
  • Republican Sen. John Ensign’s amendment (2927) limiting contingency fees to malpractice lawyers to one-third of any awards of $150,000 or less and one-quarter of any awards of more than $150,000 ( text, press release). Not an entirely terrible idea. Failed Dec. 6, 32-66.
  • Democratic Sen. Blanche Lincoln’s amendment (2905) limiting the tax deductibility of health insurers’ executive compensation to $400,000, down from the current $1 million ( text, press statement). Applies only to health insurers participating significantly in the exchanges. Failed Dec. 6, 56-42. (This amendment required 60 votes to pass.)
  • Democratic Sen. John Kerry’s amendment (2926) stating health reform won’t cut home health benefits. This amendment is meant to suggest that Sen. Mike Johanns’ motion (see below) was unnecessary ( text). Passed Dec. 5, 96-0.
  • Republican Mike Johanns’ motion ( text, floor statement) to strip from the health reform bill $42 billion in cuts to home health care agencies. Failed Dec. 5, 41-53.
  • Democratic Sen. Debbie Stabenow’s amendment (2899) guaranteeing that participants in the privately managed Medicare Advantage program won’t lose basic Medicare benefits under health reform ( text, press statement). What’s unsaid is that many Medicare Advantage participants will lose benefits that they receive above and beyond those basic benefits. But that’s only fair. Medicare Advantage, a failed 2003 experiment in market economics, receives 14 percent more on average, per enrollee, than the regular Medicare program. The health reform bill would eliminate that discrepancy. In June, the government’s Medicare Payment Advisory Commission concluded the current arrangement is “unfair to taxpayers and beneficiaries not enrolled in [Medicare Advantage] plans who subsidize those payments.” The Stabenow amendment passed Dec. 4, 97-1.
  • Republican Sen. John Thune’s amendment (2901) removing Community Living Assistance Services and Supports (CLASS), a proposed new voluntary program for nursing-home and other long-term care insurance, from the bill ( text, floor statement). Failed Dec. 4, 51-47. (This amendment required 60 votes to pass.)
  • Democratic Sen. Sheldon Whitehouse’s amendment (2780) requiring that any surpluses generated by health reform for Social Security or CLASS be reserved for those programs ( text, press statement). Passed Dec. 4, 98-0.
  • Republican Sen. Orrin Hatch’s motion to strip the bill of cuts to the privately administered Medicare Advantage program ( text, press statement). Failed Dec. 4, 41-57.
  • Democratic Sen. Michael Bennet’s amendment (2826) reassuring everybody that nothing in the bill will cut Medicare, hence there’s no need to strip anything out; see McCain amendment, below ( text, press statement). Passed Dec. 3, 100-0.
  • Republican Sen. John McCain’s motion to strip the bill of Medicare cuts ( text, press statement). McCain proposed more than twice as many Medicare cuts to fund his own health plan during the 2008 election. McCain is unbelievably touchy about this! His amendment failed Dec. 3, 42-58.
  • Republican Sen. Lisa Murkowski’s amendment (2836) barring the U.S. Preventive Task Force from being used to deny coverage for anything ( text, press statement). Failed Dec. 3, 41-59.
  • Republican Sen. David Vitter’s amendment (2808) amending Mikulski’s amendment (see below) to prevent the United States Preventive Task Force from restricting mammograms ( text, press statement), which it can’t do anyway. (Vitter is a well-known feminist.) Passed by unanimous consent Dec. 2.
  • Democratic Sen. Barbara Mikulski’s amendment (2791) to expand preventive health screenings for women ( text, summary). Passed Dec. 3, 61-39.

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