WASHINGTON — Senate Democrats said Saturday that they had clinched an agreement on a far-reaching overhaul of the nation’s healthcare system and forged ahead with efforts to approve the legislation by Christmas over Republican opposition.
As the Senate convened in a blizzard, Democratic leaders hailed a breakthrough that came when Sen. Ben Nelson, D-Neb., agreed toback the bill after 13 hours of negotiations on Friday, making him the pivotal 60th vote for a measure that President Barack Obama has called his top domestic priority.
“Change is never easy, but change is what’s necessary in America,” Nelson said at a morning news conference. “And that’s why I intend to vote for health-care reform.”
Obama, appearing on television from the White House, said: “Today is a major step forward for the American people. After nearly a century-long struggle, we are on the cusp of making healthcare reform a reality in the United States of America.”
Nelson committed his vote after winning tighter restrictions on insurance coverage for abortions, as well as increased federal health-care aid for his state.
With Senate leaders increasingly confident that they would pass the bill, Nelson pointedly warned that he would oppose the final version if negotiations with the House, which approved its bill last month, result in changes that he does not like.
But House liberals are expected to resist some concessions made in the Senate, including the dropping of a proposed government-run health insurance plan, or public option, to secure the votes of centrist holdouts.
The legislation, the most significant overhaul of the nation’s health-care system in more than a generation, seeks to extend health benefits to more than 30 million uninsured Americans.
Because the Democrats nominally control 60 seats in the Senate - the number needed to overcome Republican filibusters - every senator in the Democratic caucus effectively has veto power over the bill. No Republican is willing to support it.
“The lines are drawn,” said Sen. Richard Burr, R-N.C. “He has to get 60 votes. If he doesn’t get 60 votes, the American people win. If he does get them, America’s payback will come in the form of the 2010 elections.”
Not all Democrats have said publicly they will vote for the bill, but Senate leaders and senior White House officials believe they have agreement.
Lawmakers who attended a private meeting between Obama and Senate Democrats at the White House on Tuesday pointed to remarks there by Sen. Evan Bayh, D-Ind., as providing some new inspiration.
Bayh said that the healthcare measure was the kind of public policy he had come to Washington to work on, according to officials who attended the session, and that he did not want to see the satisfied looks on the faces of Republican leaders if they succeeded in blocking the measure.
The measure would extend health benefits by expanding Medicaid and providing subsidies to help moderate-income people buy private insurance. It would require nearly all Americans to obtain health insurance or pay financial penalties for failing to do so.
The nonpartisan Congressional Budget Office said the legislation would cost $871 billion over 10 years, with the expense more than offset by revenue from new taxes and fees and by reductions in government spending, particularly in slowing the growth of Medicare.
Senate Majority Leader Harry Reid, D-Nev., racing to complete the bill by his self-imposed Christmas deadline, on Saturday morning introduced a 338-page package of last-minute amendments, including the main provisions needed to win Nelson’s support.
Republicans, who vowed to use every procedural weapon to stop the bill, immediately forced a reading of Reid’s proposal, which wrapped up at 4 p.m., well ahead of the midnight deadline to keep Democrats on track for a final vote on Christmas Eve.
Procedural hurdles still lie ahead, including at least three votes that will require unanimous support by the Democratic caucus. The absence of even one senator could upend the process.
Under the deal worked out with Nelson, health-insurance plans would not be required or forbidden to cover abortions, but states could prohibit the coverage of abortions by plans that are offered for sale through new government-regulated marketplaces.
The amendment also includes, solely for Nebraska, a special extension of increased federal contributions to the cost of an expansion of Medicaid, the state-federal insurance program for the poor.
For weeks in floor speeches and news conferences, Republicans have warned that the health-care bill would spell disaster, raising taxes and hurting families and small businesses by increasing health-care costs in the long term and hurting senior citizens by reducing medical services.
“This bill is a legislative train wreck of historic proportions,” said the Republican leader, Sen. Mitch McConnell of Kentucky.
Sen. Olympia Snowe, a Maine Republican who had been considered a possible Democratic ally, said she would oppose the measure because it is being rushed.
Central to the deal to win Nelson’s support was an agreement on the issue of insurance coverage for abortions. Nelson wanted airtight restrictions, but an amendment that he proposed to add them to the bill was defeated on Dec. 8 by abortion-rights supporters.
Under Reid’s amendment, some health plans receiving federal subsidies could offer coverage for abortion, but they could not use federal money to pay for the procedure. They would have to use money taken from premiums paid by subscribers and would have to keep it separate from federal money.
Nelson’s concessions on the abortion language in the bill angered many supporters in his state.
The 69-year-old Nelson, a former insurance executive considered the most conservative Democrat in the Senate, had been under considerable pressure from others in his party to provide the 60th and deciding vote for Senate passage of sweeping health-care legislation. But supporters say that will pale in comparison to the heat he’s likely to face at home for softening his position.
“He’d be toast,” Mary Jo Bousek said at a protest of the legislation at Nelson’s office near the state capital. “I have friends who are Republicans who voted for him because they’re very pro-life.”
Since his first election to statewide office in 1990 as governor, Nelson has consistently opposed abortion. He was running for the Senate in 2000 when the U.S. Supreme Court invalidated a 1997 Nebraska state ban - signed into law by Nelson - on the procedure that abortion opponents call partial-birth abortion.
Also Saturday, Senate Democrats inserted a last-minute provision into their healthcare overhaul that would tax the use of tanning beds, citing concerns over skin cancer.
The 10 percent sales tax would be imposed on individuals who purchase tanning services, but would not apply to what the bill called “phototherapy by a licensed medical professional.” Most tanning salons are not staffed by medical personnel.
The tanning tax would help pay for the overhaul by raising an estimated $2.7 billion over 10 years. It replaces a proposed excise tax on elective cosmetic surgery that previously had been included in the bill. The “botax” would have raised more than twice the amount as the tanning tax. But cosmetic surgeons, who claimed that it would discriminate against middle-class women,launched a successful lobbying campaign against it.
A senior Democratic aide, who spoke on condition of anonymity because he was not authorized to discuss the issue, said the tanning tax was added out of “concern that use of these tanning beds creates a health problem with respect to cancer.” Information for this article was contributed by Carl Hulse and David M. Herszenhorn of The New York Times; by Ken Thomas, Margery A. Beck, Timberly Ross and Nate Jenkins of The Associated Press; and by Kim Geiger of the Los Angeles Times.
Front Section, Pages 1 on 12/20/2009