Finish line on health care ‘is finally in sight’


WASHINGTON — Senate Democratic leaders Wednesday unveiled a
sweeping $849 billion plan to overhaul the nation’s health care system, a
proposal likely to trigger an epic Senate battle over how consumers will buy
and maintain coverage.

The Senate could vote as early as Saturday to begin debate
on the measure, which would require most people to obtain insurance and create
a government-run insurance plan, or public option, starting in 2014, in which
states could choose to not participate.

The legislation, which the nonpartisan Congressional Budget
Office estimates should shave $127 billion from the federal deficit over the
next 10 years, the biggest projected savings of any major health care bill thus

It would bar insurers from denying coverage because of pre-existing
conditions and set up exchanges, or marketplaces, where consumers could easily
compare coverage and rates, and provide federal help for lower-income people to
obtain policies.

Getting the 2,074-page bill approved promises to be a
lengthy, arduous struggle, but an unusually optimistic Senate Majority Leader
Harry Reid, D-Nev., said “tonight begins the last leg of this journey
we’ve been on for some time . . . the finish line is finally in sight.”

Sixty votes are needed to begin debate on the measure, and
Senate leaders said they’re confident they will get the votes to proceed after
talking with three wavering moderates, Arkansas’ Blanche Lincoln, Louisiana’s
Mary Landrieu and Nebraska’s Ben Nelson.

Nelson said while he remained undecided, the possible
Saturday vote shouldn’t be seen as a judgment on the bill’s substance. “It
is a motion to start debate on a bill and to try to improve it,” he said.

Other moderates were also cautious. “We’ll wait and
see,” Lincoln said. Added Sen. Evan Bayh, D-Ind., “I’m going to
reserve judgment until I’ve had a chance to read it, but the numbers on deficit
reduction are encouraging.”

Republicans, who have bitterly opposed similar initiatives,
vowed to fight; Senate Minority Leader Mitch McConnell of Kentucky called it a
“yet another trillion dollar experiment,” and vowed “this will
not be a short debate.” He could find some allies among moderate

Liberals were ecstatic, though. The cost estimate was within
President Barack Obama’s goal of $900 billion, and the bill would lower the
number of uninsured by 31 million.

“What’s not to like about this bill?” asked Senate
Health Committee Chairman Tom Harkin, D-Iowa.

The long-awaited bill differs from the version passed in the
House of Representatives Nov. 7 in at least three crucial ways.

First, its government plan would permit states to “opt
out,” whereas the House doesn’t, though the CBO preliminary analysis still
figures 94 percent of eligible Americans would be covered, compared with the
current 83 percent. The House bill would result in coverage for an estimated 96

Second, the Senate measure would raise funds with a variety
of taxes, notably a tax on more expensive insurance policies — $8,500 on
policies for singles and $23,000 for families — and a 0.5 percentage point
boost, to 1.95 percent, in the Medicare payroll tax for singles with adjusted
gross incomes above $200,000, and families earning more than $250,000.

Congress’ Joint Committee on Taxation estimated the high-end
insurance tax would raise $149.1 billion over 10 years, while the Medicare tax
increase would raise $53.8 billion.

Neither provision is in the House bill, which would instead
impose an income tax surcharge on the wealthy.

Third, the Senate bill has less restrictive language than
the House on abortion, which is sure to spark a fight.

If the Senate moves ahead with consideration of the bill,
the debate is expected to last until lawmakers leave for a holiday recess in
late December and perhaps continue into January.

If the Senate passes a bill, it would have to be reconciled
with the House version. A negotiating committee of both chambers’ leaders would
craft the compromise, and both chambers would then have to approve it sometime
early next year.

The Senate debate is expected to include efforts to change
almost every aspect of the massive bill. As Sen. Christopher Dodd, D-Conn., a
key architect of the legislation, said Wednesday, “this is a dynamic

The public option, for instance, is expected to be tested in
several ways. Some senators are likely to seek a vote on a public option
similar to the one approved by the House.

Sen. Kent Conrad, D-N.D., has pushed “co-ops,” or
non-profit, member-run insurance groups that would provide coverage, and Sen.
Tom Carper, D-Del., is floating the idea of having the government set up a
private, nonprofit firm that would make insurance available in states that did
not have what Washington saw as affordable coverage.

“I don’t think we’ve even been given all the options
people might consider,” Dodd said.

Another key test of the bill’s strength is likely to involve
abortion. Anti-abortion Democrats nearly derailed the House bill earlier this
month, until they got a last minute concession that bars federal money from
paying for abortions except in the cases of rape or incest or where a woman’s
life is in danger.

Anti-abortion senators from both parties have vowed to
oppose the bill unless the restrictions are included. Sen. Orrin Hatch, R-Utah,
said Wednesday he expects to propose language similar to that adopted in the

Via McClatchy-Tribune News Service.