It's really done.
After more than a year of debate, the House and Senate put the final touches on the healthcare overhaul Thursday, passing changes to the new law that locks up President Obama's signature domestic policy issue.
The House passed the technical changes, contained in a reconciliation package, 220-207, after a short debate Thursday evening. The House already passed the initial reconciliation bill Sunday night when it approved the main overhaul bill.
The Senate, which passed the reconciliation bill 56-43 earlier Thursday, had to make tweaks after the first House passage based on a parliamentarian ruling that two student loan provisions violated the Byrd Rule. The Byrd Rule requires every piece of a reconciliation bill to directly affect the budget.
The reconciliation bill makes changes to the overhaul legislation Obama signed Tuesday. Democrats added student loan language to make the deficit reduction numbers required by reconciliation add up.
Republicans attempted to drag out the final House debate Thursday night.
In a floor statement kicking off debate on the fixes, Rules Chairwoman Louise Slaughter called the roadblocks a "surprise."
"Does it really make sense to anyone that the other side is demonizing a bill that's already been approved by both the House and Senate and signed into law?" she asked.
Rules ranking member David Dreier explained that Republicans were critical of the handling of the fixes, because, he said, the Rules Committee had just met and the measure was rushed to the floor under what's called a "martial law rule." While Democrats did call the Rules meeting at the last minute, the changes to the reconciliation bill amounted to 20 words.
The Senate endured 12 hours of "vote-a-rama" on more than 40 Republican amendments beginning Wednesday evening, with a break in between until the final vote Thursday afternoon. Democrats turned back each amendment.
Democratic Sens. Ben Nelson of Nebraska and Blanche Lincoln and Mark Pryor of Arkansas voted against the reconciliation bill during the Senate vote. Sen. Johnny Isakson, R-Ga., did not vote. He was released from a Georgia hospital Thursday after suffering a bacterial infection.
Nelson objected to the student loan language, and Lincoln did not support using reconciliation. Pryor objected to the substance, mainly, he said, that Arkansas' Medicaid costs for enrolling users will double, wealthy Americans will be taxed for unearned income, and employers who do not offer health insurance will face significantly larger fees.
"As more and more details of the package were released, I spent considerable time weighing the benefits and drawbacks to Arkansas," said Pryor, who voted for the main overhaul bill. "In the end, I believe this legislation is a step we don't need to take."
The reconciliation bill increases federal subsidies to help those without employer-sponsored insurance purchase coverage; closes the Medicare Part D doughnut hole; increases Medicaid funding for most states; and pushes back implementation of a tax on high-cost health plans until 2018 while raising the threshold for plans eligible for the tax.
In a comedic bit of déjà vu, Senate Majority Leader Reid once again voted "no" at first, immediately switching his vote to "yes," just as he did Christmas Eve when the Senate passed the main overhaul measure. Just as he did that December morning, Reid looked down laughing before he gave the "yes" nod.
This article appears in the March 27, 2010, edition of National Journal Daily.