This was a vote on final passage of legislation making major changes in the national health care system. The legislation, among other things, imposed a requirement that most Americans have health insurance, added 15 million people to the HYPERLINK "http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/medicaid/index.html?inline=nyt-classifier" \o "Recent and archival health news about Medicaid." Medicaid rolls, provided funding to subsidize the purchase of private health insurance coverage for low- and middle-income people, and prohibited insurance companies from refusing coverage because of “pre-existing conditions.”

Deputy Senate Majority Leader Durbin (D-IL) was among those leading the support for the legislation. He argued that the bill will “expand (insurance) coverage to 30 million more Americans (and end) . . . abuses by health insurance companies.” Durbin said there has been a long-standing “battle” between consumers and insurers, and that the legislation “is about (W)ho will win . . . the American people or the health insurance companies (and passage of the bill will mean) . . . “it will be the American people.” Durbin also argued: “(I)f you believe (health care) is a privilege for those who are wealthy . . . then you will vote against this. If you believe it is a right . . . that should be extended to more Americans . . . join us in supporting it.”

Durbin also claimed the legislation “is the greatest deficit reduction bill in the history of the United States. We have now been told by the Congressional Budget Office this bill will not only reduce our deficit over the next 10 years by over $130 billion, but in the following 10 years, their new calculation is it will reduce the deficit of the United States up to $1.3 trillion. . . It achieves this by . . . (bringing) down the increase in costs in health care.”

Sen. Harkin (D-IA), another supporter of the bill, said it sends an “important message to Americans . . . that your insurance company can no longer discriminate against you . . . .”

Sen. Grassley (R-IA) said he opposed the bill because, if implemented, "taxes are going to go up . . . premiums are going to go up . . . (and) inflation in health care is not going to go down." Sen. Enzi (R-WY), another opponent, did acknowledge: “This country needs health care reform”. However, Enzi claimed that the legislation the Senate was considering “fails to address “the reasons that reform is needed.” Enzi said the bill “would raise taxes by $493 billion (and) . . . these taxes will only increase (insurance) costs, making health care even more unaffordable.”

Enzi also claimed it would “still leave 24 million people without insurance coverage.” He argued that the increased taxes the bill would impose on employers to help pay for the costs of the bill would “eliminate millions of American jobs and reduce wages for millions of American workers.” Enzi also argued: “The bill . . . eliminates consumer choices, requiring Americans to buy richer types of plans that cover more of the deductibles and cover more out-of-pocket expenses. These plans typically have much higher premiums.”

Sen. Snowe (R-ME) focused her opposition partly on the provisions in the legislation imposing an increased Medicare payroll tax on high-income individuals and a new excise tax on high-premium insurance policies. Sen. Alexander (R-TN), another opponent, argued that the bill was just “an expansion of the current system” of which the Democrats were so critical.

The legislation passed by a vote of 60-39 along straight party lines. All sixty “aye” votes were cast by Democrats. All thirty-nine “nay” votes were cast by the Republicans present. As a result, the Senate passed a major health care reform bill, which would have to be reconciled with the House-passed version of the bill before becoming law.