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Changes clear way for Senate health bill

Compromise brings vital 60th vote on board for health-care overhaul.

WASHINGTON - Senate passage of historic health-care legislation seemed all but assured yesterday after Democratic leaders made changes that would limit federal abortion funding, increase Medicare taxes on the wealthy, and create a federally supervised health-care alternative.

The changes helped persuade Nebraska's Sen. Ben Nelson, the last apparent Democratic holdout, to agree to provide the 60th and decisive vote to cut off a Republican-led debate. That vote is expected around 1 a.m. tomorrow, with a final vote on the bill now likely on Wednesday or Christmas Eve.

As a result, "We stand ready to pass a bill into law that finally makes quality health care a right for every America, not a privilege," said Sen. Christopher J. Dodd (D., Conn.), one of the bill's chief architects.

President Obama agreed.

"It now appears that the American people will have the vote they deserve on genuine reform that offers security to those who have health insurance and affordable options for those who do not," he said at the White House. "These are not small changes. These are big changes. They're fundamental reforms. They will save money. They will save lives."

The $871 billion bill, expected to cut $132 billion from the deficit over 10 years, would require nearly everyone to obtain health insurance.

By 2019, about 94 percent of eligible Americans are expected to have coverage, up from the current 83 percent, according to the nonpartisan Congressional Budget Office.

The legislative gridlock, which had persisted for days, ended early yesterday when Nelson and party leaders announced a breakthrough that would restrict public funding of elective abortions and provide an estimated tens of millions of additional Medicaid dollars to Nelson's state.

"I know this is hard for some of my colleagues to accept, and I appreciate their right to disagree," he said of the abortion language. "But I would not have voted for this bill without these provisions."

Liberals who had fought hard to make federal abortion funding more available in the new health-insurance plans acknowledged they had to make concessions to get the bill moving.

The House of Representatives' health-care bill would put strict limits on federal funding of abortion, allowing such funds to be used only in cases of rape, incest or when the mother's life in endangered. If the Senate passes its bill with the Saturday language, negotiators, or conferees, will craft a compromise plan early next year.

"What we're building here is not a mansion, it's a starter home," said Senate Health Committee Chairman Tom Harkin (D., Iowa). "This is not the end of health-care reform, it's the beginning of health-care reform."

Republicans vowed to keep fighting. They required Senate clerks yesterday to read the 383 pages worth of the latest changes to the bill, and they plan to continue extended debate until Democrats, who control 60 Senate seats, cut them off.

"This bill is a legislative train wreck of historic proportions, but they're so eager to claim a victory they'll simply do anything to jam it through in the next few days," said Senate GOP Leader Mitch McConnell of Kentucky.

McConnell, though, appeared to be almost out of ammunition. Once Nelson gave his assurance he would vote with the party, Senate Majority Leader Harry Reid (D., Nev.) introduced a "manager's amendment," or compromise that included some changes, largely aimed at wooing party centrists.

"This bill does so many good things for so many people," Reid said.

The centerpiece is to have health-insurance companies offer plans nationwide, under the supervision of the federal Office of Personnel Management. At least one would be nonprofit, similar to those now offered by many Blue Cross-Blue Shield plans, and at least one plan would not include abortion coverage.

The federally supervised plan was hardly the "public option" that the White House and Democratic congressional leaders had so avidly sought.

Sen. Arlen Specter (D., Pa.) said that he would prefer a bill with a government-run health-insurance program to compete with private insurers but that the measure set to pass the Senate was "about as far as we can go" politically. If the Senate passes it, the bill will go to a conference committee to reconcile differences with the House version.

There is a public option in the House health bill, but Specter said that it would be difficult to do better because of the opposition of moderate Democratic senators and the need to have 60 votes to pass major legislation. He compared passing a health-care bill to civil-rights legislation in the 1960s; it takes time and progress comes in increments.

"We couldn't have had the Civil Rights Act of 1965 if we hadn't taken a step in 1957 and another in 1964 that people think didn't go far enough," Specter said in a conference call with reporters yesterday.

Reid's suggestion that Medicare, the government insurance program for people over 65 and some others with disabilities, could be expanded to include 55- to 64-year-olds, another attempt at an expanded public option, was thwarted by a group of party moderates.


CBO study likely to fuel health-care debate. A6.