A final package of changes to a landmark healthcare reform law must be approved again by the U.S. House of Representatives after the Senate parliamentarian struck two minor provisions on Thursday, according to Reuters. Senate Parliamentarian Alan Frumin upheld two Republican challenges on points of order under budget reconciliation rules, Senate Democratic aides said, requiring another vote by the House just days after it passed the package on Sunday. The points of order involved the revamp of the student loan program included in the package, said Jim Manley, a spokesman for Senate Democratic leader Harry Reid. Under the reconciliation rules, each provision in the package must have a budgetary impact. The decision came as the U.S. Senate met in a middle-of-the-night session to try to finish the bill, which would put the finishing touches on the sweeping healthcare overhaul signed into law by President Barack Obama on Tuesday. The decision could set up another politically difficult vote in the House, which narrowly passed the $940 billion overhaul and the companion bill of final changes to cap a yearlong political struggle. "We are confident the House will quickly pass the bill with these minor changes," said Kate Cyrul, a spokeswoman for Tom Harkin, Democratic chairman of the Senate Health Committee. The ruling came after Senate Democrats had managed to fend off 30 Republican amendments designed to derail the bill. The amendments were meant to force Democrats to cast difficult political votes before November's congressional elections. Democrats methodically rejected them in an around-the-clock voting spree that started on Wednesday and stretched into the early hours of Thursday. The Senate adjourned, and will resume debate later on Thursday. The rejected Republican amendments included proposals to deny erectile dysfunction drugs to sex offenders, to ensure that insurance premiums do not increase under the law, and to prevent tax increases for families earning less than $250,000. 'ATTEMPT TO DESTROY THIS BILL' The Senate's approval of even one of the amendments also would have sent the entire package back to the House for another vote, and Democratic senators vowed to prevent that. "It's very clear there is no attempt to improve this bill. There is an attempt to destroy this bill," Reid said as the voting entered its ninth hour. "Not a single one has been adopted. I don't know what they are trying to accomplish here." Republicans had met with the parliamentarian through the evening on Wednesday in hopes of finding language in the bill that could be challenged under budget reconciliation rules that require every provision have a budgetary impact. Those rules allow passage by a simple majority of 51 votes, rather than the 60 needed to overcome procedural hurdles. The ruling means 16 lines will be stricken from the bill, but that is enough to require House action once again. One of the changes was technical, Manley said, and the other involved a provision in the Pell Grant student aid program. "These changes do not impact the reforms to the student loan programs and the important investments in education," Cyrul said. The package of changes to the healthcare overhaul, approved in the House on Sunday, includes an expansion of subsidies to make insurance more affordable and more state aid for the Medicaid program for the poor. It also would eliminate a controversial Senate deal exempting Nebraska from paying for Medicaid expansion costs, close a "doughnut hole" in prescription drug coverage and modify a January deal on a tax on high-cost insurance plans. The final package would extend taxes for Medicare, the federal health insurance program for the elderly and disabled, to unearned income. It also includes reform of the student loan program. The overhaul signed by Obama represents the biggest changes to the health system in four decades. It expands insurance coverage to 32 million Americans and imposes new regulations like barring insurance companies from refusing to cover patients with pre-existing medical conditions.
