Senate bill passes test

WASHINGTON -- Landmark health care legislation backed by President Barack Obama passed its sternest Senate test early today, overcoming Republican delaying tactics on a 60-40 vote that all but assures its passage by Christmas.

"Let's make history," said Sen. Tom Harkin, D-Iowa, shortly before the bill's supporters demonstrated their command of the Senate floor in a holiday season showdown.

The bill would extend coverage to more than 30 million Americans who now lack it, while banning insurance company practices such as denial of benefits on the basis of pre-existing medical conditions.

The atmosphere was partisan, but the outcome preordained as senators cast their votes from their desks, a practice reserved for issues of particular importance. Administration officials who have worked on the issue watched from the visitor's gallery despite the late hour. So, too, Vicki Kennedy, the widow of Sen. Edward M. Kennedy, D-Mass., who championed health care across a Senate career that spanned more than 40 years.

Sen. Ben Nelson of Nebraska announced Saturday that he had decided to support the bill, for a variety of concessions, and his decision cemented the Democrats' 60-vote majority behind a bill assembled at the direction of Majority Leader Harry Reid of Nevada.

Republicans conceded Democrats had the votes but said they had not heard the end of it.

"One can stop it, or everyone will own it," said Sen. Mitch McConnell of Kentucky, the Republican leader, a warning that his party will use the issue in the 2010 midterm elections.

In an attack on Obama, he said, "A president who was voted into office on the promise of change said he wanted lower premiums. That changed. He said he wouldn't raise taxes. That changed. He said he wanted lower costs. That changed. He said he wouldn't cut Medicare benefits. That changed."

But Reid countered with a list of Nevadans who he said have suffered at the hands of insurance companies. "On average, an American dies from lack of health insurance every 10 minutes. That means that in the short time I have been speaking, our broken system has claimed another life."

Nelson came in for criticism from Republicans in Washington, who complained that he had won favorable treatment for his home state's Medicaid program. In a bit of political theater, they sought to open the bill up to extend it to all 50 states, but Democrats objected.

Nelson's agreement to an abortion-related change in the bill drew criticism from Nebraska Right to Life, a longtime supporter, and the state's Catholic bishops, who issued a statement that they were "extremely disappointed" in him.

His rebuttal came in the form of his vote and a statement. "Too many Nebraskans struggle more each year to pay rising health care costs," he said. "Too many fear or face bankruptcy and too many are left behind, unable to obtain basic health coverage for themselves and their families."

The vote, the first of three planned this week aimed at cutting off different debates, found Democrats united and determined toward anticipated passage of historic health care legislation late Wednesday or Thursday. If that happens, the Senate bill will have to be reconciled with the version the House of Representatives passed last month.

Most of the talk Sunday on Capitol Hill centered on the clashes ahead over abortion, taxes and the public option.

Resolving the differences will be up to a conference committee, which is expected to be dominated by lawmakers from both chambers close to Reid, and House Speaker Nancy Pelosi, D-Calif.

The House version would bar federal funding of elective abortions except in cases of rape, incest or in which the life of the woman is endangered.

The Senate bill would ensure that no public funds will be used for abortion, except those now allowed, and require that every state provide an insurance plan option that does not cover abortion. Plans that offer abortion coverage would have to keep an account for private premium dollars and another for federal money, and consumers would have to pay separately for the coverage. The measure provides each state the right to pass a law barring insurance coverage for abortion within state borders.

The Congressional Budget Office has estimated the legislation would reduce deficits by about $132 billion over a decade and possibly much more in the 10 years that follow. Republicans counter the figures are illusory because they depend on cuts to Medicare that will never take place.

The Senate legislation would create a new insurance exchange in which consumers could shop for affordable coverage that complies with new federal guidelines. Most Americans would be required to buy insurance, with subsidies available to help families making up to $88,000 in income afford the cost.

In a bow to Senate moderates, the measure lacks a government-run insurance option of the type that House Democrats placed in their bill. Instead, the estimated 26 million Americans buying coverage through new insurance exchanges would have the option of signing up for privately owned, nonprofit nationwide plans overseen by the same federal agency office that supervises the system used by federal workers and members of Congress.

Senate Democrats warned that any major divergence from their bill could demolish their consensus.

"Anybody who's watched this process can see how challenging it has been to get 60 votes," Sen. Kent Conrad, D-N.D., said on "Fox News Sunday."

Nelson won several changes, including tougher restrictions on abortion coverage and an estimated $45 million in federal Medicaid funds, enough to cover his state's costs of complying with an expansion of the program mandated by the bill.

Vermont and Massachusetts also won additional Medicaid funds; plastic surgeons were persuasive in their bid to strip out a proposed tax on elective surgery; hospitals in the Dakotas, Wyoming and Montana won additional Medicare funds; and more money went to hospitals in Hawaii to treat the uninsured.

McClatchy Newspapers and Los Angeles Times contributed to this report.