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RALEIGH — Despite the drama and hype surrounding the U.S. House’s 220-215 vote on health system reform, there is still a long way to go.

Senators will soon vote on their own version of reform that will be different enough from the House plan to require a compromise.
Then, each chamber will have to vote a second time.

“In the Senate, I think this debate will go on for weeks,” Sen. Richard Burr said in a phone interview last week as he watched the House gear up for the debate.

The Winston-Salem Republican has helped draft a Republican alternative to plans offered by Democrats, but that measure has been largely ignored by the committees handling health reform.

Burr and most Republicans differ with Democrats on several key points, the most well-known of which may be provisions that would create a federally backed public health insurance option for those who can’t otherwise get health insurance.

Sen. Kay Hagan, a Greensboro Democrat, has said she favors the public option provision that will be included in a draft of health reform sent to the Senate floor by her party’s leaders. Burr opposes such an option.

In the House on Saturday, Democratic leaders not only had to overcome Republican opposition but skittishness within their own ranks.

All six North Carolina Republicans voted against the bill crafted by Democratic House Speaker Nancy Pelosi, including Rep. Howard Coble of Greensboro and Virginia Foxx of Banner Elk.

In debate on the bill earlier in the week, Coble said he had heard from constituents who “fear the Pelosi health care plan will leave the gate wide open for introduction of overwhelming governmental involvement (in health care). I believe that fear is well founded.”

Democratic Reps. Brad Miller of Raleigh and Mel Watt of Charlotte, who both represent parts of Guilford County, embraced the bill.

The two are known for being among the more progressive members of their parties.

“There are currently over 129,000 uninsured individuals in my district,” Watt said in a statement Saturday night. “I am proud to have voted for this step toward real health care reform, and I hope the Senate will soon finish its work on a bill we can send to the president’s desk.”

Caught between the two sides are blue-dog Democrats, more conservative members of their party who break with liberals over certain issues.

To help appease this wing of the party, House Democrats allowed a vote on an amendment that would not allow any federally funded health plan to pay for abortions. That amendment passed and is part of the measure sent to the Senate. Coble and Foxx backed that measure; Miller and Watt opposed it.

Rep. Larry Kissell, a Biscoe Democrat, sided against the abortion provision but bucked his party on the final passage vote. Kissell said he could not vote for the bill because of cuts it made to Medicare.

Democrat Bob Etheridge, a conservative Democrat from eastern North Carolina, voted with Republicans on the abortion amendment but backed his party on the final health care vote. His vote was watched closely because he is said to be considering a run against Burr in 2010.

Advocates on both sides of the issue reacted to the vote by rallying their troops to pressure the Senate and urging their members to speak out on the vote.

Clifford Sanford of Elon took the opportunity to write Coble, his congressman, in an e-mail. “Your vote on the health care bill is, in my opinion, a desertion of your commitment to represent the citizenry of your district,” Sanford wrote.

Reached by phone Sunday, Sanford said he had written Coble earlier this year asking him to back the bill.

Contact Mark Binker at (919) 832-5549 or mark.binker@news-record.com.