WASHINGTON -- The Senate health bill scheduled for passage Christmas Eve would provide federal health care to nearly half a million more North Carolinians, force individuals to purchase health insurance and offer subsidies for households earning up to $88,000 a year for a family of four.
The historic vote comes after months of intense lobbying from residents, advocates and industries throughout the Tar Heel state. It also reflects the diametrical views of the state's two senators. U.S. Sens. Richard Burr and Kay Hagan voted with their parties and on opposite sides in a key procedural vote early Monday on the issue.
Expect them to do the same in two more key votes expected today and on the bill's final Senate passage, which could come as late as 7 p.m. Thursday.
Hagan, a first-year Democrat, labels the bill imperfect but one that would expand coverage and do away with practices in insurance such as gender discrimination and pre-existing conditions.
Many liberal senators remained unhappy despite voting "yes"; but in a statement after the vote, Hagan, a moderate, called the legislation "pro-patient, pro-consumer and pro-senior."
Burr, a Republican seeking re-election, voted "no." He says the bill would put too much control in the hands of government officials and federal advisory panels.
"For Christmas, I truly believe the American people would take a lump of coal before they'd take this health care bill," Burr said to a crowd of more than 1,000 protesters on Capitol Hill last week.
The bill expands insurance to an estimated 31 million people, but it would shift 15 million of those people onto Medicaid, the government-run insurance program for the poor. Families earning up to 133 percent of the poverty level, about $29,300 for a family of four, would qualify.
"I've said from the beginning that we ought to come up with a plan that covers everybody," Burr said in an interview Monday. "I think most would agree that Medicaid is the most inefficient delivery of care in the country."
And because the bill only guarantees full federal support to states for five years, he warned, the shift could eventually wind up costing the state about $800 million a year in Medicaid costs.
"Now, you've got this influx of people to qualify for Medicaid," he said. "At some point North Carolina has to pick up 10 percent of the costs."
Burr also criticized the last-minute deals that Majority Leader Harry Reid brokered with several holdout senators. Those included Medicaid funding for Nebraska to appease Democratic Sen. Ben Nelson.
The bill that the Senate expects to pass this week differs from the House version in several ways.
The House bill pays for changes through taxes on those earning more than a million dollars a year, while the Senate version includes a package of taxes, including one on tanning salons.
The House had its version of a public option. In the Senate, Reid dropped the public option that Hagan helped negotiate last summer in the health committee.
This fall, she trod carefully around the debate, but Hagan supported the Senate bill, saying it would help jobless and working-class residents find affordable health coverage.
The final Senate legislation includes half a dozen amendments written at least in part by Hagan.
Among them were provisions to protect farmers from paying fines if they don't provide health insurance to seasonal workers, new requirements to track state-by-state progress in fighting diabetes and an expansion of a program that helps pharmacists monitor patients' medication.
She also stressed Monday that the bill would cut long-term costs of health care.
"This bill will reduce the deficit, which has been a requirement of mine all along," Hagan said in a statement.
North Carolina interests have played significant roles in the debate, with local companies and agencies spending nearly $5 million in the first half of the year to influence the legislation.
Blue Cross and Blue Shield of North Carolina earned notoriety with two of its lobbying efforts -- an anti-reform advertising campaign whose storyboard was leaked to the Washington Post, and a postcard mailing that would have encouraged Hagan to oppose reform.
The pharmaceutical industry, which employs more than 100,000 people in the state, pushed hard against an amendment that would allow for re-importation of drugs from Canada. Both Hagan and Burr opposed the amendment.
Both also supported an amendment that Hagan helped write on allowing generic biologic, or enzyme-based, drugs to be sold in the United States. The amendment gives years of protection to brand-name biological drugs from generic drug competition.
