Overhaul bill clears latest test in Senate

WASHINGTON - Democrats crushed yet another Republican filibuster yesterday and pushed legislation to remake the nation's health-care system a step away from passage in the Senate.

The 60-39 procedural vote marked the third time in as many days that Democrats have posted a supermajority needed to advance the legislation.

Final passage, set for dawn today, was a certainty, and will clear the way for talks with the House on a final compromise. Those negotiations likely will stretch into February.

The Senate has met for 24 consecutive days to debate the legislation, the second-longest such stretch in history, and Democrats held a celebratory news conference.

"We stand on the doorstep of history," said Majority Leader Harry Reid (D., Nev.), who painstakingly pieced together the bill - and the now-controversial deals with wavering lawmakers that made its passage possible.

The measure would extend coverage to an estimated 31 million who lack it, while banning the insurance industry from denying benefits or charging higher premiums on the basis of existing medical conditions.

The Congressional Budget Office predicts the bill will reduce deficits $130 billion over 10 years, an estimate that assumes lawmakers carry through on hundreds of billions of dollars in planned cuts to insurance companies and doctors, hospitals, and others who treat Medicare patients.

Obama has also said he wants legislation that slows the rate of growth in medical spending nationwide, but the CBO said it had not determined whether that is the case with the bill.

Unlike the House measure, the Senate's omits a government-run insurance option, which liberals favored to apply pressure on private insurers, but Democratic moderates opposed as an unwarranted federal intrusion into the health-care system.

In a PBS interview, Obama signaled he will sign a bill even if it lacks the provision.

"Would I like one of those options to be the public option? Yes. Do I think that it makes sense, as some have argued, that, without the public option, we dump all these other extraordinary reforms and we say to the 30 million people who don't have coverage, 'You know, sorry. We didn't get exactly what we wanted?' I don't think that makes sense."

Outnumbered Republicans stubbornly played out a losing hand. They launched last-minute attacks that Democrats swatted aside.

"Tomorrow the Senate will vote on a bill that makes a bad situation worse," said Sen. Charles E. Grassley (R., Iowa). "This bill slid rapidly down the slippery slope to more and more government control of health care."

Republicans seized on a CBO analysis that disputed a claim by overhaul proponents that Medicare savings in the bill would help finance expanded coverage and postpone the bankruptcy of the medical program for the elderly.

The nonpartisan agency told the Republicans the $246 billion it projected the legislation would save Medicare cannot finance new programs and help pay future expenses for elderly covered under the federal program.

Sen. Jeff Sessions (R., Ala.), who requested the CBO analysis, accused Democrats of "a colossal manipulation."

Even before the bill passed, it was spinning off legal controversies at a remarkable rate.

Republican attorneys general in seven states discussed a court challenge to part of the bill that singles out Nebraska for special treatment, a concession made by the White House and Reid to lock in the state's Sen. Ben Nelson, a Democrat, as the 60th vote for the legislation.

Under the provision, the federal government would permanently pick up the state's entire cost for an expansion of Medicaid, while paying the full tab for the other 49 states for only three years.

Nelson, who has strongly defended the provision, told reporters: "The governor said, 'Take care of it.' I did." Asked whether the governor, Republican Dave Heineman, had said he did not want the money, Nelson replied: "He hasn't said it to me."

A spokeswoman for the governor later said he did not want a "special deal." But the issue underscored the potential political dilemma facing Republicans in Washington who oppose additional funding that governors of their own party may want.

Senate Republicans also laid out two other avenues for a court challenge.

Sen. John Ensign (R., Nev.) argued that the measure was unconstitutional, saying Congress lacks authority to require Americans to buy insurance.

Sen. Kay Bailey Hutchison (R., Texas), who is running for governor, said the bill usurped the authority of the states to regulate insurance.

In a concession to the season, Republicans agreed to move up the vote on final passage by one hour, to 7 a.m.