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Senate nears showdown on health bill

The final vote will come early tomorrow. Advocates are confident of passage.

WASHINGTON - From the White House to Capitol Hill, Democrats yesterday confidently predicted Senate passage of President Obama's health-care overhaul after the bill cleared a second 60-vote test and a time was set for a final tally.

Coming to the Senate floor in the middle of the afternoon, Majority Leader Harry Reid (D., Nev.) announced an agreement with Republicans - rare in the health-care debate - to vote on final passage at 8 a.m. tomorrow, Christmas Eve, rather than in the evening. It would mark the 25th consecutive day of Senate debate on health care.

"The finish line is in sight," Finance Committee Chairman Max Baucus (D., Mont.) said at a news conference with other Senate leaders and cheering supporters.

At the White House, spokesman Robert Gibbs declared: "Health-care reform is not a matter of if. Health-care reform is now a matter of when."

Senate Democrats remained behind their compromise bill over steadfast Republican opposition. A motion to shut off debate and move to a vote on a package of changes by Reid passed 60-39. The final 60-vote hurdle, limiting debate on the bill itself, is expected to be cleared this afternoon, setting up tomorrow's vote on the legislation, which at that point will need only a simple majority to pass.

The Senate has been voting at odd hours since Monday around 1 a.m. because Republicans have insisted on using all the time allowed under Senate rules to delay the bill. Not to be thwarted, Reid has refused to postpone action until after the holidays. Yesterday, they started voting at sunrise.

Americans will feel the pain before the gain from the overhaul. Proposed taxes and fees on upper-income earners, insurers, even tanning parlors, take effect quickly. So would Medicare cuts.

Benefits such as subsidies for lower middle-income households, consumer protections for all, and eliminating the prescription coverage gap for seniors, will come gradually.

"There's going to be an expectations gap, no question about that," said Drew Altman, president of the nonpartisan Kaiser Family Foundation. "People are going to see their premiums and out-of-pocket costs go up before the tangible benefits kick in."

Most of the 30 million uninsured helped by the bill won't get coverage until 2013 at the earliest, well after the next presidential election.

Altman thinks Democrats won't be able to resist the temptation to keep tinkering with the legislation to improve or speed up coverage. "The legislation is going to be out there, and politics can change," he said. "There's a potential for modification and amendment."

Health-care overhaul could be back for an encore.

Yesterday, with fatigue and frustration rising, Reid appealed to his colleagues to set aside acrimony and reach for some holiday spirit.

"I would hope everybody will keep in mind that this is a time when we reflect on peace and good things," he said. Republican Leader Mitch McConnell of Kentucky said he, too, wanted to close the debate. After conferring with McConnell, Reid announced the timing of the final vote.

Even so, partisan fires were burning.

GOP Sen. Lindsey Graham of South Carolina denounced concessions won by conservative Nebraska Democratic Sen. Ben Nelson, whose support gave Democrats the 60th and final vote they needed.

Among other things, Nelson got an agreement that the federal government will pay to expand Medicaid services in Nebraska. "That's not change you can believe in. That's sleazy," Graham said on NBC's Today show.

South Carolina Attorney General Henry McMaster, a candidate for governor, said yesterday that he and his counterparts in Michigan and Washington state are investigating whether the special provisions for Nebraska and other states are constitutional.

Reid has defended the deal-making, asserting that every senator got something he or she was looking for in the health bill and if they didn't, it speaks poorly of them.

Moderate Sen. Mary Landrieu (D., La.), who has been criticized for securing a boost in Medicaid for her state, defended the concessions she got, saying they benefited low-income families and small businesses.

Also yesterday, Sen. Bill Nelson (D., Fla.) announced that the inspector general of the Department of Health and Human Services has agreed to his request to investigate whether drug companies are raising the prices of brand-name prescription drugs used by Medicaid and Medicare beneficiaries ahead of passage of the health-care bill.

AARP, the seniors' lobby, said prescription drug prices are on the rise, but the Pharmaceutical Research and Manufacturers of America said Nelson's request "was spurred, in large part, on misleading statistics and sensationalized media reports."

The Senate measure would still have to be harmonized with the health-care bill passed by the House in November before final legislation goes to Obama.

There are significant differences between the two bills, including stricter abortion language in the House bill, a new government-run insurance plan in the House bill that's missing from the Senate version, and a tax on high-value insurance plans embraced by the Senate but strongly opposed by many House Democrats.

Senate moderates have served notice they won't support a final deal if government-run insurance comes back. Democratic abortion opponents in the House say a Senate compromise on the volatile issue is unacceptable.

But there's considerable pressure on Democrats to avoid messy negotiations over a final bill. Public support for the legislation continues to sink in opinion polls.

The bills probably have more in common than differences. Each costs around $1 trillion over 10 years and installs new requirements for nearly all Americans to buy insurance, providing subsidies to help lower-income people do so. They're paid for by a combination of tax and fee increases, and cuts in projected Medicare spending.

Unpopular insurance-company practices such as denying coverage to people with existing health conditions would be banned.

Uninsured or self-employed Americans would have a new way to buy health insurance, via marketplaces called exchanges where private insurers would sell health plans required to meet certain minimum standards.