WASHINGTON — Senate Republicans waged a last-ditch battle late Wednesday to derail the last element of an overhaul of the nation’s health care system. But as night fell, the GOP was making little headway, and Democrats predicted that they were just hours away from pushing the measure to final passage.

Republicans offered dozens of amendments to the measure – a package of “fixes” to the bill that President Obama signed into law Tuesday – with a goal of forcing it back to the House for another vote. But when the Senate began voting on the amendments shortly after 5 p.m., each proposal was easily rejected.

“Today, Republicans will give Democrats one last chance to reject the horrible impact the underlying bill and this last-minute add-on will have on our country,” Senate Minority Leader Mitch McConnell, R-Ky., said Wednesday. “Unfortunately, we already know that they plan to turn the other way.”

The defeated amendments would have altered central elements of the health care law. One would have rescinded more than $500 billion in Medicare cuts, a key source of funding to make health insurance affordable to an estimated 32 million additional people over the next decade.

Another proposal would have eliminated an array of smaller provisions that benefit particular states or regions, provisions Republicans derided as “sweetheart deals” whose only purpose was to win the support of specific Democratic lawmakers.

Other amendments would have stripped the bill of tax increases that hit individuals who make less than $200,000 a year – upholding Obama’s campaign pledge not to raise taxes on the middle class, Republicans said – and erased a requirement that employers offer affordable coverage to their workers or face penalties.

Under another proposal, offered by Sen. Charles Grassley, R-Iowa, Obama and members of Congress would have been required to buy insurance through state-run insurance exchanges created by the legislation starting in 2014. The amendment failed, but the White House announced that Obama would use the exchange anyway, apparently assuming he will win re-election in 2012. That prompted Grassley to quip: “This is a little presumptuous.”

Maine’s two U.S. senators, Olympia Snowe and Susan Collins, were among those calling for changes in the reconciliation bill. Snowe and Collins joined other GOP senators criticizing elements of the law and calling for amendments that would force another up or down House vote on the entire measure.

Collins criticized the new law and the pending reconciliation bill for penalizing employers of more than 50 workers with “job-killing fines” at a time when Congress should be encouraging them to hire more employees. She proposed an amendment waiving the penalties when a company hires someone who was unemployed.

Snowe said the final law includes too many new taxes and costs that could harm businesses. And it lacks any concrete cost controls to contain runaway premiums, she said.

As the Senate staged a series of rapid-fire votes on the amendments, only a handful of Democrats defected, suggesting that the fixes package would easily be approved in the final vote. The package of fixes was written under special budget rules, known as reconciliation, that protect it from a Republican filibuster, so just 50 Democratic votes are needed to send the bill to Obama for his signature, completing the most significant social legislation in nearly a half-century.

Although much smaller than the bill Obama has already signed, the fixes measure would make major changes to that legislation to bring the final package in line with a compromise worked out between House and Senate leaders. Federal subsidies would be expanded slightly for people who need help buying insurance, and the coverage gap known as the doughnut hole in the Medicare prescription drug program would be closed by 2020. Seniors who hit the doughnut hole this year would be eligible for a $250 rebate.

The fixes package would also change the annual penalty on individuals who do not purchase insurance to at least $695 a year or as much as 2.5 percent of annual income. And it would dramatically increase the penalty facing employers who do not offer affordable coverage, to as much as $2,000 per worker.

The most significant change, however, is the method of financing the overhaul. A new 40 percent excise tax on high-cost insurance policies would be delayed until 2018 and replaced by a new tax on the nation’s highest earners. Families earning more than $250,000 a year would for the first time have to pay a 3.8 percent Medicare payroll tax on capital gains, dividends and other investment income.


Staff Writer John Richardson contributed to this report.


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