By John Whitesides and Donna Smith
WASHINGTON (Reuters) - U.S. Congressional Democrats scrambled on Thursday to complete a package of fixes to landmark healthcare reforms already signed into law as President Barack Obama headed to Iowa as part of a public relations blitz to sell the new plan.
The Senate was expected to vote on the package of revisions on Thursday and send them to the House of Representatives, where House Democratic Leader Steny Hoyer said a final vote could come as early as on Thursday night.
After signing the historic overhaul of the $2.5 trillion (1.68 trillion pound) healthcare system earlier this week, Obama will to try to promote the sweeping changes to Americans, shown by polling data to be wary of the law.
Republicans solidly oppose the reforms and have vowed to make repealing it a major issue in mid-term congressional elections in November.
"The president believes it is important to continue to talk about the many aspects of the law that will do precisely what he said they're intended to do," White House spokesman Robert Gibbs said on Wednesday.
The House narrowly gave final congressional approval to the $940 billion healthcare overhaul on Sunday along with the companion bill of final changes after a bitter yearlong struggle.
As Congress worked through final fixes to the overhaul, the Morgan Stanley Healthcare Payor index of health insurers rose 0.8 percent in morning trading, roughly in line with the broader market. UnitedHealth Group rose 1.2 percent, while Aetna increased 2.1 percent.
Meanwhile, a second major U.S. manufacturer said on Thursday the healthcare reform would cause a huge rise in after-tax costs. Farm equipment maker Deere & Co. said it expected healthcare costs to rise by $150 million this year. Equipment maker Caterpillar last week estimated the reform would raise its costs by more than $100 million.
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The overhaul signed by Obama was his top legislative priority and 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.
The package of revisions, demanded by House Democrats, was approved by the House on Sunday and includes an expansion of subsidies to make insurance more affordable, an adjustment in state aid for the Medicaid program for the poor and an improvement to the Medicare prescription drug benefit for the elderly. It also would eliminate a controversial Senate deal exempting Nebraska from paying for Medicaid expansion costs.
The final package also would extend taxes for Medicare, the federal health insurance program for the elderly and disabled, to investment income. It also includes reform of the student loan program.
In a final stand against the healthcare overhaul, Senate Republicans pushed dozens of amendments designed to force Democrats to take difficult political positions before November's elections.
Democrats were methodically rejected the amendments in an around-the-clock voting spree that started on Wednesday and stretched into Thursday, and were optimistic they would fend off those challenges and send the package back to the House largely intact.
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.
The package must go back to the House after the Senate parliamentarian upheld two Republican challenges under procedural rules, Senate Democratic aides said.
The challenges involve the package's revamp of the student loan program, said Jim Manley, a spokesman for Senate Democratic leader Harry Reid. Under reconciliation rules, each provision in the package must have a budgetary impact.
The decision set up another potentially difficult vote in the, but House Speaker Nancy Pelosi said Democrats would have the votes to pass it again.
(Editing by David Alexander and Vicki Allen)
