Casting its first votes on revamping the nation's health care system, the Senate rejected a Republican bid Thursday to stave off Medicare cuts and approved safeguards forfor women.
The first round of votes ended with a fragile Democratic coalition hanging together.
Senators voted 58-42 to rejectby Sen. John McCain, R-Ariz., that would have stripped more than $400 billion in Medicare cuts from the nearly $1 trillion measure. It would have sent the entire 2,074-page bill back to the Senate Finance Committee for a redo.
Republicans said the proposed cuts to health insurance plans and medical providers mean seniors in the popular Medicare Advantage program will lose benefits. And they predicted lawmakers will ultimately back away from the cuts, once seniors start feeling the brunt.
"Medicare is already in trouble. The program needs to be fixed, not raided to create another new government program," said Republican leader Mitch McConnell of Kentucky.
Democrats said seniors will not lose any guaranteed benefits. The cuts - amounting to a 2 percent slowdown in spending - will help keep Medicare solvent by making it more efficient, they contended. And they pointed out that the health care overhaul bill improves preventive care and prescription coverage.
"My colleagues on the Republican side have resorted to the politics of fear to preserve a broken health care system," said Sen. Tom Harkin, D-Iowa. "What we're hearing are scare tactics designed to mislead seniors."
AARP, the seniors' lobby, threw its weight behind the Democrats.
The votes Thursday came after three days of angry debate in which Democrats accused Republicans of stalling to try to kill the bill, and Republicans protested that they were only exercising their right to give the complex legislation full scrutiny.
The first votes were held under a special agreement requiring 60 votes to prevail. That tested the coalition Democrats are counting on to move President Barack Obama's signature issue. The margin was close on the women's health amendment, which aims to safeguard coverage of mammograms and preventive screening test under a revamped system.
The 61-39 vote on a provision by Democrat Barbara Mikulski of Maryland and Republican Olympia Snowe of Maine was the first substantive ballot in an acrimonious debate that promises to go on for weeks.
After that will come an amendment to restrict abortion funding, except in cases of rape, incest or to save the life of the mother. Drafted by an abortion opponent - Democratic Sen. Ben Nelson of Nebraska - it looms as a major challenge for the Democrats.
Though Democrats have 60 votes in the Senate, two Democratic senators voted against the Mikulski amendment - Russ Feingold of Wisconsin and Nelson. The measure was saved by three Republicans voting in favor - Snowe, David Vitter of Louisiana and Susan Collins of Maine.
Thursday's vote followed the heated controversy over a government advisory panel's recent recommendation that routine mammograms aren't needed for women in their 40s. Although the advisers' recommendation was nonbinding, it prompted fears that the health care legislation would usher in an era of rationing.
The Mikulski amendment gives the health and human services secretary authority to require health plans to cover additional preventive services for women. The Congressional Budget Office said the amendment would cost $940 million over a decade
Mikulski said her amendment would guarantee that decisions are left to women and their doctors, not placed in the hands of government bureaucrats or medical statisticians. She accepted a modification to her amendment by Vitter that would specifically prevent the controversial recommendations on mammograms from restricting coverage of the test.
However, Republicans said that Mikulski's amendment still left too much discretion to the HHS secretary. A competing amendment by Sen. Lisa Murkowski, R-Alaska, would prevent the government from using the recommendations of outside advisers to deny coverage of preventive services, including mammograms and Pap tests. It was defeated by on a vote of 41-59.
The Medicare vote went to the heart of seniors' concerns that cuts from the program used to finance coverage for the uninsured will undermine the quality of their care.
Furious with opposition from AARP, McCain railed on the Senate floor and delivered a message to seniors:
"Take your AARP card, cut it in half and send it back. They've betrayed you," he said.
Underscoring the political stakes, McCain, recorded "robocalls" in states that are home to key moderate Democrats asking voters to support McCain's amendment stripping the bill's Medicare cuts. The calls, paid for by the National Republican Senatorial Committee, targeted Nelson, Bennet and Blanche Lincoln of Arkansas.
"On Monday, I introduced the first Republican amendment to the massive health care bill, which would send the bill back to the Senate Finance Committee and stop the Democrats from cutting vital Medicare coverage for our seniors. I need Sen. Blanche Lincoln to join me in this effort," McCain says in the call heard by Arkansas residents.
He asks them to go to an NRSC Web site and sign a petition to Lincoln "urging her to join my effort to fight a Washington, D.C., government takeover of your health care."
The scripts in the other states were identical. Another call by a live operator was heard by voters in North Dakota, which prohibits robocalls, and it delivered the same message, targeted at Sen. Byron Dorgan.
Two Democrats voted with McCain against the Medicare cuts, Nelson of Nebraska and Jim Webb of Virginia.
A competing amendment by Sen. Michael Bennet, D-Colo., underscoring that no benefits in traditional Medicare will be cut by the legislation, was approved 100-0.