First key vote today on Senate health bill

WASHINGTON — After negotiating critical last-minute commitments, Senate Democratic leaders are on the verge of having the necessary 60 votes to begin consideration of the most expansive health-care legislation to go before the Senate in nearly half a century.

Two Democratic holdouts, Sen. Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, said this morning they will vote "yes" on a crucial test vote today that will allow debate on the health-care bill to proceed.

Senate Majority Leader Harry Reid, D-Nev., needs 60 votes to prevail in the 100-seat Senate. The 40 Republicans are unanimously opposed.

The Senate would start formal debate on the Democrats' top domestic priority when lawmakers come back from their Thanksgiving recess Nov. 30 — beginning with consideration of a series of proposed amendments from both sides of the aisle.

The House of Representatives has already passed its version of health-care legislation, which will ultimately have to be reconciled with the Senate bill.

The Senate measure, which would cost $848 billion over 10 years, is designed to eventually expand coverage to another 31 million Americans, while restraining federal deficits and taking steps to make the nation's health-care system more efficient and reliable for patients.

It is funded by a politically delicate mix of cuts to the federal Medicare system and new taxes on health-care industries, high-end "Cadillac" health plans and wealthy households.

Politically charged

The measure is so politically charged that finding the votes even to take up debate on the legislation turned into a Capitol drama that dragged on for weeks.

With Republican lawmakers determined to filibuster every stage of the legislative process, all of the 58 Democratic senators and the two independents who caucus with them must hold together to move any health-care legislation.

That has forced the majority leader, Reid, a veteran parliamentary strategist, to cut numerous side deals to satisfy the demands of individual lawmakers in his caucus. Reid included language in his bill that would boost aid for Louisiana's Medicaid insurance program for poor people in a bid for Landrieu's support.

He also slashed proposed new taxes on the medical-device industry to ease the concerns of Democrats, such as Indiana's Sen. Evan Bayh, from states that are home to large device makers.

Oregon deal

And on Friday, Reid struck a deal with Oregon Sen. Ron Wyden, who has been pressing to allow more Americans access to new insurance exchanges where commercial insurers would compete to offer plans to consumers who do not get health benefits through work.

Wyden's proposal, which Reid agreed to add to the bill, would open the exchanges to about a million workers who could not afford the health plans offered by their employers, according to an estimate from the nonpartisan Congressional Budget Office.

Republican lawmakers have kept up a steady effort to make it more difficult for conservative Democrats to vote to open debate, casting the parliamentary move as a referendum on the health-care bill itself.

This "vote is something we need to look at as a vote that's not some sort of ... a procedural vote," Sen. Judd Gregg, R-N.H., said on the Senate floor Friday. "It's a substantive vote on whether or not we're going to fundamentally change the way health care is delivered in this country."

Sen. Ben Nelson, D-Nebraska, firmly rejected that characterization.

"It is only to begin debate and an opportunity to make improvements," he said in a statement Friday. "If you don't like a bill, why block your own opportunity to amend it? ... I won't slam the doors of the Senate in the face of Nebraskans now. They want the health-care system fixed. The Senate owes them a full and open debate to try to do so."

Uneasy about measure

Nelson has indicated unease about several key components of the legislation, including the creation of a new government-insurance plan and restrictions on federal funding for abortion, which Nelson said he wants to see strengthened.

Demands like these, which figure to define the upcoming debate, will likely complicate Reid's attempt to pass the health-care legislation even if he prevails on the procedural motion.

The rules of the Senate will require Reid to cobble together 60 votes again to end debate on the health-care bill and bring it up for a final vote, which he hopes to do before Christmas.

Several lawmakers who oppose the government insurance plan, including Sen. Joe Lieberman, Ind-Conn., said they would not vote for a bill unless the "public option" provision is removed.

They may back an amendment during the upcoming debate that would create a "trigger." Under such an arrangement, a government plan could only be created in parts of the country where commercial insurers did not meet benchmarks for quality and affordability.

Liberal lawmakers, meanwhile, plan to seek other changes, including more aid to low-income Americans to help them buy health insurance.

Sen. Bernie Sanders, Ind-Vt., said that although he will support today's procedural vote, his support for a final bill is "not at all guaranteed."