Health bill approaches key vote in Senate

By Lori Montgomery and Shailagh Murray
Monday, December 21, 2009; A01

After a week of high-profile concessions, Senate Democrats were on the brink early Monday of securing a milestone victory in the health-care debate, as White House officials sought to refocus attention on the bill's far-reaching insurance reforms and other potentially major changes.

Senators were expected to hold a rare 1 a.m. procedural vote, the first of three before final passage of the legislation, now scheduled for Christmas Eve. But a difficult closing round of negotiations, culminating in a series of compromises with moderates, threatened to overshadow the significance of what Democrats believed they were close to achieving.

"This bill is the product of years of hard work, study and deliberation," said Senate Finance Committee Chairman Max Baucus (D-Mont.), one of the principal sponsors of the package, in remarks on the Senate floor late Sunday. "These are the reforms for which Americans have been waiting."

Not a single Republican is expected to support the package, including Sen. Olympia J. Snowe, the one GOP lawmaker who had backed an earlier version of the bill. The Maine moderate was lobbied heavily by President Obama, but announced Sunday night in a statement that she remained "concerned" about the measure, while objecting to "the artificial and arbitrary deadline of completing the bill before Christmas."

While admittedly outflanked, Republican opponents declined to relent. Sen. John McCain (R-Ariz.), who ran against Obama for president last year, vowed to "fight until the last vote," a threat that could keep senators at their desks until well into the night on Dec. 24.

Responding to liberals, who have pounded Senate leaders for caving in on such issues as abortion coverage and the creation of a government-run insurance plan, the White House and its allies acknowledged in newspaper op-ed pieces and on television talk shows that the $871 billion Senate package is not ideal. But they argued that the measure would transform the health-care system, both for people who have insurance and for 31 million Americans who otherwise would go without.

"This is major reform," White House senior political adviser David Axelrod said on NBC's "Meet the Press." "It's not perfect. And over time, it may improve," he said.

Senate Democrats, meanwhile, prepared for a final round of votes on Majority Leader Harry M. Reid's revised package, before sending the measure on to a House-Senate conference committee. After a grueling stretch of dealmaking, Reid (D-Nev.) announced this weekend that he had won the support of Sen. Ben Nelson (D-Neb.), giving him the 60th vote, needed to overcome a Republican filibuster.

Senate Minority Leader Mitch McConnell (Ky.) held out hope that Democrats would stumble in delivering every caucus member to the Capitol at odd hours and through nearly two feet of snow.

"People have to show up, and people have to vote. At least three more times," he told reporters. Even if Democrats clear that hurdle, he said, "this is not over, by any stretch."

If the Senate approves a bill, negotiations with the House are expected to drag into January. The gulf between the House and Senate versions has widened over the past three weeks, as Democratic moderates wary of excessive government intrusion into the private sector forced Reid to abandon even the weakened version of the government-run insurance option he tried to add to the Senate package.

Last week, under pressure from Sen. Joseph I. Lieberman (I-Conn.), Reid also scrapped a proposed substitute for the public option that would have extended Medicare eligibility to uninsured people as young as 55. Last month, the House approved a $1 trillion package that includes a government-run insurance plan, and many House liberals want to keep the provision alive to apply competitive pressure to the private insurance industry.

The House and Senate are at odds over other issues, such as how to pay for the health initiative and how to bar federal funding for abortion under legislation that would offer federal insurance subsidies to those who lack affordable coverage through an employer. Nelson, an opponent of abortion, insisted on a provision that would require people who receive the new subsidies to write two checks each month, one for their share of the premium and the other specifically to pay for abortion coverage.

The compromise has infuriated both opponents and advocates of abortion rights. On Sunday, the leaders of the influential House abortion rights caucus, Reps. Diana DeGette (D-Colo.) and Louise M. Slaughter (D-N.Y.), complained that it is "not only offensive to people who believe in choice, but it is also possibly unconstitutional." But other Democrats defended the compromise, urging their colleagues to focus on the broader benefits of the Senate bill.

"This shouldn't be the forum for the debate on abortion," Richard J. Durbin (Ill.), the No. 2 Democrat in the Senate, said on ABC's "This Week."

Vice President Biden and Victoria Reggie Kennedy, the widow of Sen. Edward M. Kennedy (D-Mass.), hit the same themes in op-ed pieces published Sunday, urging advocates of the public option to embrace consumer protections in the Senate bill. Even former Democratic Party chairman Howard Dean, who last week counseled senators to scrap the bill and start over, told NBC's David Gregory that the bill is better now, despite "this last week of unseemly scrambling for votes," and that he would let the measure proceed to conference.

"While it is not perfect, the bill pending in the Senate today is not just good enough -- it is very good," Biden wrote in the New York Times. " "I share the frustration of other progressives that the Senate bill does not include a public option," Biden wrote. "But . . . those in our own party who would scuttle this bill because of what it doesn't do seem not to appreciate the magnitude of what it has the potential to accomplish."

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