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Senate health-care bill unlikely to include Medicare buy-in

Sen. Sherrod Brown (D-Ohio), another champion of the public option, told reporters: "I want to see health-care reform. There's going to be a good bill."

Sen. John D. Rockefeller IV (D-W.Va.), the lead liberal negotiator of the buy-in deal, said he was willing to drop the measure, for the sake of moving the bill forward. "We're not going to get all that we want," he said. "But we're going to get so much more than we have."

Monday night's meeting was unusually long for the Senate, and it featured numerous speeches. One passionate endorsement of the bill came from Sen. Arlen Specter (D-Pa.), who switched parties earlier this year. Specter urged his Democratic colleagues, "Don't let those obstructionists win," one participant recalled.

The room erupted in applause when Specter reminded the group, "I came to this caucus to be your 60th vote." But soon after the speech, Sen. Ben Nelson (D-Neb.) left the session early, telling reporters he remained undecided.

Democrats said they were confident that their colleagues would overcome lingering concerns. "To use an old cliche, the general consensus was we shouldn't make the perfect the enemy of the good," Sen. Evan Bayh (Ind.) said as he left the meeting.

Late Monday, Reid sought to settle other unresolved issues that are preventing the bill from moving forward. He spent much of the afternoon trying to satisfy Nelson's concerns about abortion coverage, said Reid spokesman Jim Manley. That effort is expected to continue Tuesday.

Under pressure from AARP, an influential lobby for retirees, Senate leaders also agreed Monday to close the annual gap in Medicare prescription drug coverage known as the "doughnut hole." The gap leaves beneficiaries to pay for their own medicine after they have received $2,700 worth of covered drugs. Coverage picks up again when drug costs hit $6,100, but few seniors make it through the hole to the other side.

The bill approved by the House on Nov. 7 would close that gap, but the more cost-conscious Senate had offered only to narrow the gap temporarily by $500 in 2010. Speaking on the Senate floor late Monday, Reid and the two primary sponsors of the legislation -- Baucus and Sen. Christopher J. Dodd (D-Conn.) -- lamented the plight of seniors who are unable to afford medicine and vowed to include provisions to close the doughnut hole in final negotiations with the House.

"We have already taken the first steps to fix this in the current bill, closing the gap by half and by an additional $500 for 2010. Because I am committed to saving lives, saving money and saving Medicare, I am committed to fully closing it, once and for all," Reid said. "The legislation we will send to President Obama for his signature will make good on his promise and ours to forever end this indefensible injustice for America's seniors."

Closing the gap was AARP's top priority in the Senate, and the group had signaled that it could withdraw its tentative support for the bill without that change. In a letter to Reid late Monday, AARP chief executive A. Barry Rand thanked Senate leaders for their commitment to solve the problem and offered his endorsement of the bill.

"We understand, given Senate constraints, that this action must wait until conference," Rand wrote. "With your commitment to closing the doughnut hole in conference, consistent with the President's pledge . . . AARP is pleased to support your efforts to obtain cloture, and urges timely passage of this legislation by the Senate."

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