In the first showdown over the Senate health care bill, Democrats on Thursday successfully defended more than $400 billion in Medicare cuts, turning back a potentially lethal stab at the measure.
On a 58-42 vote, the Senate defeated an effort by Sen. John McCain, Arizona Republican, to send the bill back to a committee where lawmakers would have had to drop the cuts in Medicare payments and instead find another way to pay for the bill, which overhauls the nation's health insurance system and guarantees coverage for tens of millions of people who lack insurance.
"This isn't the first time defenders of our broken health care system have tried to scare seniors, and it won't be the last," said Sen. Christopher J. Dodd, Connecticut Democrat and chairman of the Health, Education Labor and Pensions Committee.
With four votes Thursday, the Senate broke a stalemate that had lasted since the official debate on the bill began Monday.
In addition to the Medicare cuts vote, the Senate adopted an amendment that gives the government authority to eliminate co-payments for women's health screenings such as mammograms - and along the way turned back a Republican effort to try to stop the government from relying on task force recommendations to decide what services should be covered.
The Medicare fight was the biggest test.
Democrats argued that the cuts - totaling $464 billion over 10 years - would not affect the basic services guaranteed by Medicare, and instead would squeeze insurance companies and hospitals that are overcharging for the level of service they are providing.
They pointed to Republicans' historic opposition to Medicare as evidence that the Republicans' protests were political.
"Now they're coming riding to the rescue of Medicare; we have a right, I think, to be skeptical," said Senate Majority Whip Richard J. Durbin, Illinois Democrat, charging that Republicans were simply trying to protect insurers.
Republicans said the cuts would hurt care for seniors.
Sen. Tom Coburn, Oklahoma Republican and a doctor, said physicians will be slower to respond.
"I know what goes on inside a hospital. When you cut $130 billion out of the hospitals, the time you're going to wait between the time you push your call button is going to get extended," he said. "The complications from that are going to result in decreased quality of care and shortened life expectancies."
The AARP, the large and influential seniors lobby, opposed Mr. McCain's amendment.
Mr. McCain responded by telling seniors: "Take your AARP card, cut it in half and send it back. They betrayed you."
The cuts span payments to hospitals, hospices, nursing homes and the Medicare Advantage program, among others. With 11 million people enrolled in it, the Medicare Advantage program cuts were a particular fight.
Under special rules, Republicans and Democrats agreed to a 60-vote threshold for any of the votes to succeed Thursday.
Democrats held ranks fairly well in turning back the Republican attacks.
On Mr. McCain's amendment Democrats held all but two of their members - Sens. Jim Webb of Virginia and Ben Nelson of Nebraska. On an amendment introduced by Sen. Barbara A. Mikulski of Maryland, Democrats won by a vote of 61-39, with the support of three Republicans: Sens. Olympia J. Snowe and Susan Collins of Maine and David Vitter of Louisiana. That offset the loss of two Democrats, Mr. Nelson and Sen. Russ Feingold of Wisconsin, on that vote.
Ms. Mikulski seemed miffed by Mr. Feingold's vote. She was overheard telling colleagues on the floor: "He won't listen. He doesn't like the way I pay for it."
After the other votes were complete, all 100 senators voted for an amendment that urges the government to protect Medicare and not reduce the program's basic guaranteed benefits.
Republicans have promised to come back with more amendments on Medicare, including trying to eliminate the bill's cuts to payments to hospitals, hospices and nursing homes.
Despite losing Thursday's vote, Republicans saw a political opening. The National Republican Senatorial Committee issued press releases attacking eight Democratic senators up for re-election next year who voted against Mr. McCain's amendment.
The NRSC said the cuts would ding seniors in each of those states.
But one of their targets, Sen. Blanche Lincoln of Arkansas, said Mr. McCain's amendment was "not to protect Medicare but to frighten our nation's seniors so that they too will oppose health care reform."
She also bristled against automated phone calls that Mr. McCain taped and that the NRSC used to reach out to voters in Arkansas and other states, arguing against the bill's Medicare cuts.
The House has passed its own health care bill and is awaiting Senate action so the two chambers can hammer out a final agreement.
With far more procedural tools available to them, Senate Republicans have demanded weeks of votes.
On Wednesday, Democrats vowed to stay in session through Christmas in order to force Republicans to finish the bill this year. With little prospect of help from Republicans, Democrats will have to keep all 60 members of their caucus on board, and private meetings behind closed doors and on the Senate floor are common as leaders try to work out thorny issues with rank-and-file Democrats.
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