Long, bitter debate ahead for health care bill

Democrats called it a historic opportunity. Republicans called it a sham.

Long-awaited debate over President Barack Obama's health care overhaul kicked off in the Senate with lawmakers trading bitter partisan words over the measure to remake one-sixth of the U.S. economy.

The legislative struggle is expected to last for weeks in a test that pits GOP senators determined not to give ground against Senate Democrats determined to deliver on Obama's signature issue.

The 10-year, nearly $1 trillion legislation includes a first-time requirement for most Americans to carry insurance, greatly expands the Medicaid federal-state insurance program for the poor, and would require insurers to cover any paying customer regardless of their medical history or condition.

On Monday each side offered the first of what are likely to be dozens of amendments, with the measures seemingly designed as much to court a skeptical public as to reshape Senate Majority Leader Harry Reid's 2,074-page bill.

Sen. John McCain, R-Ariz., attacked the legislation as a "monstrosity" that employs "Bernie Madoff accounting, Enron accounting" as he offered the first GOP amendment. McCain's amendment would strip out more than $400 billion in Medicare cuts to home health providers, hospitals, hospices and others - a pitch to seniors, who polls show have deep concerns about the legislation.

Democrats planned to go on the offense on the same issue Tuesday with an amendment underscoring benefits to seniors and guaranteeing that basic Medicare benefits would not be touched.

Sen. Barbara Mikulski, D-Md., made a bid for support from women Monday with an amendment to reduce copays and deductibles for preventive services such as mammograms. Alluding to outrage earlier this month after a government-appointed panel said that women generally should begin routine mammograms in their 50s rather than their 40s, Mikulski said that under her amendment, "if your doctor says you need one, you're going to get one."

Votes on amendments are expected to begin Tuesday. "We have an historic need and we have an historic opportunity. We have an opportunity to enact groundbreaking reform that will finally rein in the cost of health care," said Sen. Max Baucus, D-Mont.

The Congressional Budget Office has estimated that 31 million uninsured individuals would receive insurance if the bill were enacted, many of them assisted by federal subsidies. The legislation would be paid for through a combination of cuts in projected Medicare payments, a payroll tax on the wealthy and taxes on drug makers, medical device manufacturers, owners of high-cost insurance and others.

It has taken months to advance the legislation to the floor, as Democrats struggled with their own internal divisions as well as Republican opposition.

Democrats control 60 seats in the Senate, precisely the number needed to trump a promised Republican filibuster, and Reid's ability to steer the bill to passage will depend on finding ways to finesse controversial provisions within the measure, such as a proposal for the government to sell insurance in competition with private firms.

Despite the public jousting, significant action was occurring behind the scenes Monday evening as Reid, D-Nev., and Baucus huddled to plot strategy with top White House and Cabinet officials including Chief of Staff Rahm Emanuel, Interior Secretary Ken Salazar and Health and Human Services Secretary Kathleen Sebelius, along with former Senate Democratic Leader Tom Daschle, Obama's first pick for HHS secretary before his nomination was derailed.

Liberals favor the government insurance plan; moderate and conservative Democrats oppose it. As drafted, the bill establishes a so-called government option, although each state can block it. Legislation passed earlier by the House also has a a government option, with no state opt-out provision; it would have to be reconciled with any Senate-passed measure before a final bill could go to Obama's desk.

A new report from the Congressional Budget Office on how the Senate bill would affect premiums gave both parties ammunition Monday.

It said that by 2016, premium prices for Americans working at large companies, about 70 percent of the under-65 population, would be between zero and 3 percent lower on average than would otherwise be the case.

At small companies, covering 13 percent of the under-65 population by 2016, the average premium would be between 1 percent higher to 2 percent lower on average.

CBO said that for individuals buying insurance on their own, 17 percent of the non-elderly population, premiums would rise by between 10 percent and 13 percent on average. But more than half that group is expected to receive federal subsidies that would result in premiums as much as 59 percent less costly on average than would happen under current law.

Those conclusions allowed Democrats to claim that their bill lowered premium costs - and Republicans to claim it drove them up.

As evening fell, Reid stepped into a Capitol elevator. "I survived the first day," he declared.

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Associated Press Writers David Espo and Charles Babington contributed to this report.