Senate conducts vote marathon on healthcare

President Obama gives a ''high five'' to 11 year-old Marcelas Owens, of Seattle, after holding a rally celebrating the passage and signing into law of the Patient Protection and Affordable Care Act health insurance reform bill while at the Interior Department in Washington, March 23, 2010.

WASHINGTON (Reuters) - The U.S. Senate launched a final marathon session on healthcare reform on Wednesday, with Republicans forcing Democrats into a series of politically tough votes before senators can pass the last changes to the landmark law.

The day after President Barack Obama signed a sweeping overhaul of the $2.5 trillion healthcare system, the Senate raced to finish a companion package of changes sought by Obama and Democrats in the House of Representatives.

Republicans offered at least two dozen amendments designed to derail the package or force Democrats to take a difficult political stance before November's congressional elections.

Democrats killed the first amendment -- ordering Medicare savings be put directly back into the federal health plan for the elderly -- on a 56-42 vote and promised to reject them all in an around-the-clock "vote-a-rama" scheduled to last into early Thursday.

The Senate's approval of even one amendment would send the whole package back to the House for another vote, just days after the House passed the sweeping $940 billion overhaul in a close vote that capped a yearlong political struggle.

"Make no mistake, the intent of every single one of the amendments on the other side of the aisle is to kill healthcare reform," said Max Baucus, Democratic chairman of the Senate Finance Committee.

The Republican amendments include proposals to deny erectile dysfunction drugs to sex offenders, to ensure that insurance premiums do not increase under the bill and to prevent tax hikes for families earning less than $250,000.

The vote on final passage could be held in the post-midnight hours on Thursday, or held over to the daylight on Thursday.

Senate Democratic leader Harry Reid ridiculed the Republican attempt to force Democrats into politically embarrassing stances.

"How serious can they be?" Reid said of Republicans. "Offering an amendment dealing with Viagra for rapists?"

Republicans promised to keep fighting the overhaul and said the amendments were designed to improve a bill that even Democrats agree needs fixing.

'SEE WHAT'S BEING DONE'

"This is called a fix-it bill. We're suggesting you fix it," said Judd Gregg, the ranking Republican on the Senate Budget Committee, rejecting Democratic claims that sending the bill back to the House would be a death sentence.

"That is absurd," he said. "We have suggested a series of amendments that will significantly improve this bill."

The package of changes to the healthcare overhaul, approved in the House on Sunday, include 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 an overhaul of the student loan program.

The overhaul signed by Obama represents the biggest changes to the healthcare system in four decades. It expands insurance coverage to 32 million Americans and imposes new insurance regulations like barring companies from refusing to cover patients with pre-existing medical conditions.

The health insurance industry has been critical of the plan, but the Morgan Stanley Healthcare Payor index of health insurers has risen about 1 percent since passage as investors were encouraged that clarity on health reform was near and the bill avoided worst-case scenarios.

The contentious healthcare debate in the House still echoed in the Capitol on Wednesday. House Democratic leaders met with Capitol law enforcement officials to discuss security after death threats and acts of violence against lawmakers accompanied the weekend vote.

Bricks were tossed through the windows of one member's office, while another lawmaker was spat at by a protester on Capitol Hill and another was the target of a racial slur. Democrats called on Republicans to reject the attacks.

"It's more disturbing to me that Republican leadership has not condemned these attacks and instead appears to be fanning the flames with coded rhetoric," said House Rules Committee Chairwoman Louis Slaughter.

Obama signed an executive order reaffirming a ban on using federal funds to pay for abortions, part of a deal with about a half-dozen anti-abortion House Democrats that won their support on Sunday.

The Democratic abortion rights opponents in the House had said they were concerned the restrictions on federal abortion funding were not strong enough in the healthcare bill.

(Additional reporting by Thomas Ferraro, Lewis Krauskopf, David Morgan; Editing by David Alexander and Peter Cooney)