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After 23 hours of debate, the Senate on Saturday evening voted to begin a formal debate of the Democrats’ health care reform bill. The vote, which was on a motion to end a Republican filibuster of bringing the bill to the floor, was approved with no votes to spare.

The motion required a three-fifths majority, or 60 votes, to pass, which is exactly the number of seats Democrats hold in the Senate. With no Republicans voting in favor, Democrats had to hold their every member of their caucus together. The Democrats are notoriously bad at maintaining the party line, and a handful of moderates in the party are have already said they will join a Republican filibuster later on if the bill is not significantly altered. But somehow they pulled it off. It’s a significant victory for Majority Leader Harry Reid [D, NV] and the Obama Administration, but it does not mean that they will ultimately be able to pass the bill.

Read, comment and link to the bill on OpenCongress: Patient Protection and Affordable Care Act.

The Democrats’ health care bill has been estimated by the Congressional Budget Office to cost $848 billion and reduce the deficit by $130 over a ten year period. It would expand health coverage to 31 million uninsured Americans. Three to four million of the newly insured individuals would be covered by a new government-run insurance plan (a.k.a the public option). The bill would require all individuals to have health insurance, and provides $447 billion to help low and moderate-income people afford plans. It would also ban many of the most egregious health industry practices, like dropping patients that get sick and denying coverage based on pre-existing conditions.

Passage of tonight’s vote was secured earlier in the day when two crucial centrist Democrats — Lincoln of Arkansas and Landrieu of Louisiana — announced that they would vote to bring the bill the bill to the floor. But both reiterated their objections to the public option included in the bill. “I am opposed to a new government administered public health care plan as a part of comprehensive health care reform, and I will not vote in favor of the proposal that has been introduced by Leader Reid as it is written,”

Sen. Lincoln said on the Senate floor. Senator Landrieu expressed a similar sentiment. “My vote today to move forward on this important debate should in no way be construed by the supporters of this current framework as an indication of how I might vote as this debate comes to an end,” she said.

When the Senate returns from Thanksgiving recess on November 30th they will take up their health care reform bill as a substitute amendment to an unrelated House bill, H.R. 3590. In order to begin the amendment process, they will have to vote to break another Republican filibuster of adopting the substitute amendment. The Democrats will need 60 votes for that, but tonight’s vote indicates that the votes will be there.

The amendment process could drag on for weeks. Dozens of amendments from both parties will be voted on, and most of them will be filibustered and require 60 votes. Senate Democrats are hoping to have a vote on final passage of the health care bill before they leave for Christmas break, but that timeline is likely to slip into 2010.

“The battle has just begun,” declared Senate Minority Leader Mitch McConnell [R, KY] on Saturday afternoon.

If and when the Senate approves a health care bill, it will go to a conference committee to be reconciled with the version passed by the House. The final version that the conference committee — known as “report” — produces will have to be approved once again by both the Senate and the House before it can be sent to President Obama to be signed into law. The conference committee report will not be open to more amendments, but it will be subject to a filibuster in the Senate and require 60 votes for passage.

The NYTimes reports: Senate Democrats said they had clinched the votes needed on Saturday to propel major health care legislation to the floor for weeks of full debate, as the majority party’s two last holdouts said that they would not block consideration of President Obama’s top domestic initiative.

Breaking news coverage: The Hill, WaPo, WSJ… more to come.

Brian Beutler is in the Capitol live-blogging the proceedings for TPM-DC: “Lincoln Voting For Debate, Still Opposes Public Option”. (That would be Sen. Blanche Lincoln [D-AR].)

Here are some tools for you to learn more and get engaged with the Patient Protection and Affordable Care Act:

• Read, comment and link to the Senate health care bill. Scroll over any section of the 2,074-page text to leave an inline comment or create a custom permalink.
• Compare the Senate health care bill to the House bill (From NYT). Click in the left-hand column to compare major features.
• See the topline numbers. Read about the Congressional Budget Office’s score of the bill on spending, deficit reduction, coverage and more. Compare the CBO Score to other versions of health care reform legislation.

More details on the OpenCongress Blog and Twitter. As you can imagine, we’ll be covering the health care debate intensively over the weeks to come, so subscribe to our blog’s RSS feed to keep up with the latest developments.

Senate Republicans today are pointing to a new CRS report to bolster their argument that a vote tomorrow to begin debate of the health care bill is a de facto vote in favor of passing the bill. According to Roll Call the report found that between 1999 and 2008, the Senate voted 41 times to approve cloture motions to begin debate of bills (the same kind of motion that will be voted on tomorrow), and of those 41 bills, 40 of them ultimately ended up being passed. That’s a 97.6 percent success rate for bills that are brought up through invoking cloture on the motion to proceed.

“Tomorrow’s vote is a critical vote because it will basically mean that we’re on the road to passage,” Sen. Judd Gregg [R,NH] said today on the Senate floor.

But here’s the thing: the vast majority of the 41 bills in the CRS report were not actually controversial. It takes only one senator to object to beginning debate of a bill and force the Senate to take a cloture vote. So often a single senator will force a cloture vote on the motion to proceed to a bill that is actually very popular and bipartisan. For example, the most recent vote the Senate took on a motion to invoke cloture on a motion to proceed to debate was on an unemployment benefits extension bill that ultimately ended up passing 98-0. Before that bill, the second most recent bill to face a cloture vote on the motion to proceed was the GIVE Act, which ended up passing on an overwhelming bipartisan vote of 79-19. Before that it was the Omnibus Public Land Management Act, which ultimately passed 77-20. Et cetera…

If you were to look at just highly controversial bills like the health care bill, the CRS report would look much less like a foregone conclusion. This isn’t scientific, and the CRS report hasn’t been made public, but the only bill in recent memory that was similarly contentious but passed the cloture motion to begin debate is the comprehensive immigration reform bill that the Senate debated during the last session of Congress. That bill ultimately failed. The Senate spent weeks voting on amendments from both sides of the aisle to try to find some kind of agreement on the bill, but in the end it failed to pass cloture on ending the debate by a vote of 45-50. Read the OpenCongress Wiki page on the bill for a good outline of the action on the bill that finally resulted in failure.

Senate Democratic leaders have been telling on-the-fence Democrats that they should vote to move the bill forward to debate because they will have opportunities on the floor to change the bill, and if they still don’t like it, they can vote it down on the cloture motion before final passage. The immigration debate of last session tells us that for bills that are this controversial, that is in fact a realistic outcome. Tomorrow’s vote is essential for passing the bill, but it does not by any means ensure final passage.

For more background on the procedure the Senate is using to bring the health care bill to the floor, see this previous blog post.

Today, the Senate begins what by all accounts will be a lengthy and contentious debate of their health care reform legislation. Unlike the House, whose health care bill was brought to the floor and approved on the same day, the Senate is embarking on a month or more of procedural votes and controversial amendments on all sorts of issues. The difference lies in the Senate rules, which give the minority party — the Republicans — much more power than in the House to stall and block legislation.

Below, I’ve outline the legislative process the Senate will be following to debate health care. But first, some important links:

• Read, comment and link to the Senate health care bill. Scroll over any section of the 2,074-page text to leave an inline comment or create a custom permalink.
• Compare the Senate health care bill to the House bill (From NYT). Click in the left-hand column to compare major features.
• See the topline numbers. Read about the Congressional Budget Office’s score of the bill on spending, deficit reduction, coverage and more. Compare the CBO Score to other versions of health care reform legislation.

Now for the convoluted procedure the Senate will be following:

The debate that begins today is, technically, on defeating a Republican filibuster of proceeding to debate of an unrelated House bill, H.R. 3590. The Democrats are bringing up the House bill instead of their own Senate bill because the Constitution requires all legislation affecting taxes or revenues to originate in the House. Since the Senate Democrats’ health care bill includes a number of tax increases and revenue provisions, they’re using the unrelated House bill as a “shell.” Its text will be completely replaced by the health care bill text, which exists in the form of a “substitute amendment,” if adopted.

On Saturday night at 8 p.m. ET, the Senate is scheduled to vote on defeating a filibuster of debating the shell bill, a motion also known as invoking “cloture.” That vote require a three-fifths majority (60 affirmative votes) to pass. If it passes, Senate Republicans can then force Democrats to wait 30 hours before the Senate can hold a simple up-or-down vote on actually proceeding to debate the shell bill. If cloture is invoked on Saturday night, that would put the up-or-down vote on proceeding to the bill on Monday morning at the earliest, though the Senate is currently scheduled to be on Thanksgiving recess then.

Once the motion to proceed has finally been approved, Senate Democrats will then move to defeat a second filibuster of considering the bill. This one will actually be on the text of the health care bill, in the form of a substitute amendment. Democrats will again have to find 60 votes just to proceed to an up-or-down vote on replacing the text of the shell bill with the health care text. That second cloture vote will most likely happen on November 30, when the Senate returns from recess. Once it passes, it would set up another up-or-down vote on December 1st to begin debate of the health care bill text proper. At that point comes the amendment process and, eventually, votes to end debate and pass the bill, which could possibly happen before Christmas but could also drag into 2010.

This Saturday’s vote is crucial. If it doesn’t pass, the health care reform effort will falter in a major way. Senate Democrats would be back to the drawing board to draft an entirely new bill designed to attract more votes. But if Saturday’s vote is successful, the bill moves forward to amendment and likely to passage. The Congressional Research Service recently found that 97.6 percent of all bills that are have cloture invoked on a motion to proceed are eventually given final approval by the chamber.

As it stands, three conservative Democrats — Nelson, Landrieu and Lincoln — have major problems with the bill and have not committed to voting on Saturday to let the debate proceed. No Republicans will be voting to allow the debate to move forward, so Senate Majority Leader Harry Reid [D, NV] needs all 60 members of his caucus to stand together and vote in favor. Asked by reporters on Thursday whether he thought he would have the votes he said only, “We’ll find out when the votes are taken.”

The Senate health care reform bill (viewable here) contains numerous provisions that stress disclosure and transparency, specifically online disclosure and transparency. These provisions acknowledge that information that is meant to be disclosed and available to the public must be made available online. The bill contains sixty-six uses of the word “Internet,” almost entirely to refer to the online disclosure of information meant for public viewing. The acceptance that disclosure must be made online shows the continued understanding that the Internet is the venue to create trust and accountability.

The Department of Health and Human Services would be required to post nearly every report filed with the Department online. These reports range from information ensuring the quality of care provided by insurers to information meant to control premium increases. The various Internet disclosure provisions include new information on hospitals, hospice care and long term care facilities. New web sites would be created to provide information on affordable health care options and for the State administered health care exchanges.

Health and Human Services would be tasked with creating an Internet portal template for state administered health care exchanges. The web site template would provide information for individuals and employers to help them determine their eligibility for the exchange. The web site would also be required to present standardized information on the plans made available in the exchange including a rating to inform users to the basis of the relative quality and price of each plan offered.

Another of the bill’s Internet disclosure targets is affordable coverage. The bill tasks Health and Human Services with creating a web site to provide information on affordable coverage in each state. The provisions targets specific types of coverage for this disclosure including private coverage that is not limited to reimbursement for any one disease or condition or an “unreasonably limited” number of diseases and conditions. Other coverage options that must be disclosed and shown to be affordable on this web site include some Medicaid coverage and coverage under S-CHIP. The web site will also include standardized information on each plan including premium rates, cost sharing, premium revenue expended on non-clinical costs, eligibility and availability.

The bill also targets health insurers with a disclosure provision. The bill aims to control what it calls “unreasonable” premium increases by requiring insurers to provide a justification for such increases prior to the implementation of the increase. The justification must be made to the Department of Health and Human Services and simultaneously posted to the insurers web site in a prominent manner that the public can see.

The word “Internet” is also used in some instances to refer to public education campaigns on prevention efforts and bridging cultural divides on health care understanding. One piece of the prevention education campaign is the creation of an online tool for individuals to judge their disease-risk and see suggestions to reduce their risk.

(h/t to my colleague John Wonderlich for his tweeted suggestion to “do a Find in Page for internet in the healthcare bill.”)

As I pointed out in a previous post, one of the decisions Harry Reid had to make in reconciling the HELP Committee and Finance Committee was whether or not to require Members of Congress to purchase their insurance the same way everyone else does. The Finance Committee would have required all Members of Congress to give up their Federal Employees Health Benefits Plan and buy insurance through the new exchanges instead, while the HELP bill would allow them to keep their exclusive health care plans.

The final bill’s out, and Reid chose to include the Finance Committee language. Straight form the bill text:

(d) MEMBERS OF CONGRESS IN THE EXCHANGE.

(i) REQUIREMENT. Notwithstanding any other provision of law, after the effective date of this subtitle, the only health plans that the Federal Government may make available to Members of Congress and congressional staff with respect to their service as a Member of Congress or congressional staff shall be health plans that are

(I) created under this Act (or an amendment made by this Act); or

(II) offered through an Exchange established under this Act (or an amendment made by this Act).

(ii) DEFINITIONS. In this section:

(I) MEMBER OF CONGRESS. The term Member of Congress means any member of the House of Representatives or the Senate.

(II) CONGRESSIONAL STAFF. The term congressional staff means all full-time and part-time employees employed by the official office of a Member of Congress, whether in Washington, DC or outside of Washington, DC.

Read the Reid health care bill on OpenCongress>>

Senate Majority Leader Harry Reid [D, NV] last night released his health care bill, which is expected to get a first initial vote in the Senate as soon as Friday. From its major features and topline numbers, the bill clearly has a lot of the attributes Senate Democrats need to meet the political challenges facing their health care reform effort. It includes a dramatically pared-down public option, greatly expands insurance coverage, reduces the deficit, maintains the status quo on abortion funding and bans many of the most egregious insurance industry practices.

But, as in most everything Congress does, the details of the bill are crucial. The OpenCongress team worked through the night to convert the 2,074-page .pdf file of the bill into HTML so we could post it online and help people dig in to find the important details. Since the bill was released as a.pdf and not filed alongside other legislation on the Library of Congress’ THOMAS website, our version is the only online copy of the bill — view it here:

The Patient Protection and Affordable Care Act>>

…We’ll be working throughout the day to build our inline commenting and section-by-section permalinking tools into the page.

The bill is a blended version of the two health care bills that were approved by the Senate Finance Committee and the Senate HELP Committee earlier this year. Those bills overlapped in several areas and had some major differences that had to be reconciled by Majority Leader Reid in the final bill released last night. Here’s an outline of some of the choices Reid was facing between the two bills.

We already know about some of his decisions. Instead of going with the HELP Committee’s public option plan with reimbursement rates tied to Medicare or the Finance Committee’s bill that eschewed the public option altogether, Reid chose a plan that would require the government to negotiate rates with providers and would allow individual states to opt out of participating. The CBO has estimated that Reid’s opt-out public option would have higher premiums on average than private plans, would insure between 3 and 4 million people and would be unavailable to about one-third of Americans, who would be residing in states that chose not to offer the plan to its residents.

All of Reid’s final decisions can be found be found by digging into the bill. We’ll be posting about them on this blog as they are discovered. Also worth looking for are provisions that are aimed at specific states to win support from wavering Democrats whose votes will be needed to overcome Republican filibusters. We know that the bill contains some new items that weren’t in either of the previous versions. There’s a new Medicare payroll tax for people making above $200,000 annually and a new 5% tax on elective cosmetic surgery.

The bill is in the form of an amendment to a House-passed veterans’ housing credit bill, H.R. 3590. That means the Senate’s first vote to break a filibuster and begin debate will not technically be on the health care bill, a fact the Dem leadership is hoping will help win support for the motion from hesitant moderates. According to Congress Daily ($), Majority Whip Dick Durbin [D, IL] is planning on arguing that all Democrats should vote to move the bill to debate so they can hash out their difference through the amendment process. That vote could take place as early as Friday, but it will likely not happen until Saturday or later. If the filibuster is overcome (it will take 60 votes), the Senate will then begin debate and amendment of the Patient Protection and Affordable Care Act.

Update: Read the bill, comment on individual sections and create custom links:

The Patient Protection and Affordable Care Act>>

Update, 10pm ET: As we type, the OC team is working on putting together a webpage of the brand-new Senate health care reform bill: The Patient Protection and Affordable Care Act (link opens in browser as a 2,074-page .pdf), released as an amendment to H.R. 3590. Our uniquely searchable + open-source HTML page will be up and linked from our homepage as soon as we can tonight.

Until then, a few early links w/ news coverage and blog reactions: NYTimes, TheHill, WaPo. Follow OC on Twitter.

Substantive links & some early analysis from Ezra Klein, who’s had the health care reform story surrounded for the WaPo from go: Primary sources on the Senate bill, Health-care reform will not be remembered for its price tag… more to come…

Previously: The health care bill that the Senate will begin debating next week won’t be released until tomorrow. But today we get to have a look at the Congressional Budget Office’s highly-anticipated analysis of the bill. The CBO analysis — known as a “score” among wonks — doesn’t tell us the details of the bill’s mechanisms, but it does tell us some core information on how much the bill costs and how effective it will be.

Generally, the CBO score looks very good for the Democrats. Majority Leader Harry Reid [D, NV] (pictured) wanted to keep the bill under $900 billion, and it is. Reid said yesterday that the CBO numbers are evidence that this is the “best” health care bill yet, adding: “I think if you’re not impressed, you should be.”

Below, I’ve put together a table comparing some of the topline CBO numbers for the health care bill that was passed by the House, the Senate Finance Committee health care bill (the leading Senate proposal up until now) and the new Senate bill. All numbers reflect the CBO’s estimates of the bills’ effects 10 years from now.

Obviously some crucial information has yet to be filled in, especially regarding subsidy levels. I’ll update as soon as the information is out. Updated!

The full bill is expected to be released at noon ET tomorrow. As soon as it’s out, we’ll be working full steam ahead to get the bill online in HTML for public comment and review. Subscribe to the RSS feed for this blog for updates.