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Senate Republicans vow to delay health-care vote

By Shailagh Murray and Lori Montgomery
Washington Post Staff Writer
Thursday, December 17, 2009; A11

Senate Republicans vowed Wednesday to use every available tactic to delay voting on the health-care bill as Majority Leader Harry M. Reid (D-Nev.) scrambled to unify Democrats in support of the legislation.

Democratic leaders continued to court Sen. Ben Nelson (D-Neb.), whose vote appeared to be the most elusive in the 60-member Democratic caucus; he was unsatisfied with language in the $848 billion legislation related to abortion coverage. Democratic leaders offered to revise the bill with tighter restrictions, but Nelson, an abortion opponent, said he was not sure the new wording would go far enough.

Meanwhile, on the Senate floor, Republicans showed they were prepared to extend the health-care debate as long as possible, with Sen. Tom Coburn (Okla.) demanding that a Senate clerk read aloud a 767-page Democratic amendment sponsored by Sen. Bernard Sanders (I-Vt.).

The GOP bid was foiled about three hours later, when Sanders withdrew his long-shot proposal to create a Canadian-style single-payer system. But Republicans are expected to make a similar move when Reid introduces the revised Senate bill, which is likely to top 2,000 pages and which cannot be similarly withdrawn.

"We ought to take and embrace this idea of transparency and responsibility that the American people can expect every one of us to have read this bill . . . and certify that we have an understanding for what we're doing to health care in America," Coburn said.

Democrats decried the maneuver and predicted that the stalling effort would fail. "The decision by the Senate Republican leadership today to have the Sanders amendment read clearly tells us what their strategy is," said Democratic Whip Richard J. Durbin (D-Ill.). "It is to slow down or stop this bill at any cost."

Durbin said the Dec. 25 deadline for passage remains in place, provided Reid can lock down the 60 votes needed to overcome a GOP filibuster. "I think that we can get this done in time for each of us to be home for Christmas. That's our goal," Durbin said.

But Nelson told reporters Wednesday that he is still undecided on the bill and will not be able to vote for the package "until and unless the things I've put before them are handled."

According to participants in the talks, the latest revision would seek to more clearly segregate public and private funds in new insurance exchanges for individuals who do not have access to affordable employer-based coverage. Under the bill, people with incomes below 400 percent of the federal poverty level would receive government subsidies to purchase plans on the exchanges.

Nelson, like numerous antiabortion groups, wants an ironclad ban on using subsidies to buy policies that include abortion coverage. Such a provision would track closely with terms in the House bill, adopted over strong objections from liberals. Abortion rights groups are pressuring Senate Democrats to resist such stringent rules, arguing that abortion access for all women could be threatened.

"There's a lot of discussion going on about it," Nelson said. "And we are now looking at language. So I don't know how to characterize it as progress or not, but if progress is language has come to us, that's progress."

Nelson also told reporters that he is waiting for antiabortion groups back home in Nebraska to weigh in. In past campaigns, Nelson has faced criticism from such organizations that he is not tough enough in his opposition to abortion -- despite his reputation among Democrats as a staunch conservative on the issue.

Sen. Barbara Boxer (D-Calif.), a leader of the pro-choice faction of the Democratic caucus, said she is hopeful that a compromise can be reached. "We're looking for those words that will just keep the status quo in play," Boxer said. "If we're real, if we all mean what we say, I feel we can do it."

But Douglas Johnson, the legislative director for the National Right to Life Committee, said the emerging language was weaker than the House's amendment, which would ban abortion coverage in plans that accept people using federal subsidies to help pay for their insurance. "This is entirely unacceptable," he said.

Despite the focus on abortion, other issues remain unresolved, and Democrats continue to push for changes to the legislation. Four senators, including Joseph I. Lieberman (I-Conn.), announced Wednesday that they would seek to significantly increase the authority of a new Independent Medicare Advisory Board that the Obama administration views as critical to reining in health-care costs.

The amendment would scrap deals to exempt hospitals and hospices from additional Medicare payment cuts over the next decade, make clear that doctors and medical-device manufacturers also could face payment cuts, authorize the board to cut Medicare spending sooner and more deeply, and ensure that the board could continue to force Congress to make Medicare cuts years into the future.

The proposal is sure to infuriate provider groups and organizations for the elderly, though the senators also propose to expand the scope of the board so it could make cost-cutting recommendations across the entire health industry, a change sought by AARP and other seniors groups.

The White House and many Democrats view the commission as one of the few items in the bill able to drive down health-care costs over the long term.

"One of the most important goals of health-care reform is reducing the cost of health care," said Lieberman, who has yet to endorse the Senate bill. "The Independent Medicare Advisory Board is one of our most effective tools to do just that."

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