The House on Wednesday voted 215-213 to approve a $602 billion Labor-HHS spending bill that reduces discretionary spending by about 1% to $142.5 billion. Last month, a slightly different version of the bill failed when all House Democrats and 22 Republicans voted against it. At least seven Republicans at the time said they voted against the bill because of cuts in funding for rural health care programs. Congressional conferees on Monday reached an agreement that shifted $180 million in health-related costs to win the support of more Republicans. The bill contains mandatory spending for programs, including Medicaid and Medicare, and "steep cuts" to programs related to medical training, community colleges, rural health care, and state and local health departments. The bill now moves to the Senate. Sen. Arlen Specter (R-Pa.), chair of the Senate Labor-HHS-Education Appropriations Subcommittee, said he expects the bill to win Senate approval, but he added, "I will vote for it if my vote is needed to pass, otherwise I will vote against. There is not enough money in it.”