Senate girds for historic debate on health bill

After months of maneuvering, the Senate stands at the brink of a historic battle over health care with President Barack Obama and his allies on one side and Republicans, outnumbered but unflinching, on the other.

"Now it's America's turn, and this will not be a short debate," Sen. Mitch McConnell of Kentucky, the Republican leader, warned after Majority Leader Harry Reid unveiled long-awaited legislation Wednesday night to extend coverage to 30 million more Americans and force insurance companies to take all comers.

"Higher premiums, tax increases and Medicare cuts to pay for more government. The American people know that is not reform," McConnell said.

Obama and Democrats hailed the 10-year, $849 billion measure that would remake the nation's health care system, relying on cuts in future Medicare spending to cover costs, as well as on higher payroll taxes for the well-off and a new levy on patients undergoing elective cosmetic surgery.

Reid, D-Nev., wrote the legislation with White House aides during weeks of secretive negotiations, selecting elements from two committee-passed bills with the aim of securing the necessary 60 votes in a Senate debate that will be decisive for Obama's health care agenda.

"From Day One, our goal has been to enact legislation that offers stability and security to those who have insurance and affordable coverage to those who don't, and that lowers costs for families, businesses and governments across the country," Obama said. Reid's bill "meets those principles," the president said.

Aides said the mammoth, 2,074-page bill would reduce deficits by $127 billion over a decade, citing estimates by the Congressional Budget Office. For the first time most Americans would be required to carry health insurance, and the bill would provide hundreds of billions of dollars in subsidies to help those with lower incomes afford coverage.

Employers would not be required to offer coverage, but medium and large companies would pay a fee if the government ends up subsidizing employees' insurance.

Reid released his legislation more than a week after the House approved its more expensive version of the health care bill on a near party-line vote of 220-215.

Reid pointedly declined to claim the 60 votes needed to clear a must-pass procedural hurdle before debate can begin. That vote could take place Saturday.

Democrats hold 58 seats in the Senate and two independents generally vote with them, but several moderate Democrats - Mary Landrieu of Louisiana, Ben Nelson of Nebraska and Blanche Lincoln of Arkansas - have yet to commit to allowing debate to begin. Reid met privately with the three before releasing his bill Wednesday, and Nelson later issued a statement strongly suggesting he would support fellow Democrats on the procedural vote.

Landrieu said she wanted more information about the bill before making a final decision, while Lincoln, the only one of the three who faces re-election next year, told reporters, "We'll wait and see."

If this weekend's vote succeeds, it would be followed by weeks - if not more - of unpredictable maneuvering on the Senate floor, where Reid and his allies will seek to incorporate changes sought by Democrats and repel attempts by Republicans to defeat the legislation and inflict a significant political defeat on the president.

Beginning in 2014, Reid's bill would set up new insurance marketplaces called exchanges, primarily for those who now have a hard time getting or keeping coverage. Consumers would have the choice of purchasing government-sold insurance, an attempt to hold down prices charged by private insurers.

The bill has many similarities to the House-passed measure, but with some important differences.

Reid called for increasing the Medicare payroll tax by half a percentage point to 1.95 percent on income over $200,000 a year for individuals, $250,000 for couples.

He also included a tax on high-value insurance policies, meant to curb the appetite for expensive care.

The House bill contains neither of those two provisions, relying on an income tax surcharge on the wealthy to finance an expansion of coverage.

On a controversial issue that threatened to derail the House legislation, Reid would allow the new government insurance plan to cover abortions and would let companies that receive federal funds offer insurance plans that include abortion coverage.

A provision in the House bill - passed at the insistence of anti-abortion Democrats over strenuous objections from liberals - banned both those things. Reid attempted to tighten up the abortion language to strictly segregate private from public funds, but that did not pass muster with the National Right to Life Committee, which issued a statement Wednesday night calling the language "completely unacceptable."

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Associated Press writers David Espo and Ricardo Alonso-Zaldivar contributed to this report.