WASHINGTON — Senate passage of historic health care legislation seemed all but assured Saturday after Democratic leaders made changes that would put limits on federal abortion funding, increase Medicare taxes on the wealthy and create a federally supervised health care alternative.
The changes helped convince Sen. Ben Nelson, D-Neb., 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. Monday, with a final vote on the bill now likely Wednesday or Thursday.
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 Dodd, D-Conn., one of the bill's chief architects.
President Barack Obama agreed.
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"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 to those for 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 the next 10 years, would require nearly everyone to obtain health insurance policies.
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, which estimated 31 million more people under 65 would become insured, leaving about 23 million without coverage.
The legislative gridlock, which had persisted for days, ended early Saturday 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.
"What we're building here is not a mansion, it's a starter home," said Senate Health Committee Chairman Tom Harkin, R-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 Saturday to read the 383 pages worth of the latest changes to the bill, and 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-Nevada, Saturday introduced a "manager's amendment," or compromise that included some changes, largely aimed at wooing party centrists.
The centerpiece is to have health insurance companies offer plans, under the supervision of the federal Office of Personnel Management, and offered nationwide. At least one would be non-profit, 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.
Reid's suggestion last week 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 small group of party moderates.
Party leaders Saturday urged looking at all the other items in the bill. "This bill does so many good things for so many people," Reid said.
Insurers would have to spend more of their premium revenue on care, with less going to administrative costs and profits, or else they would have to pay rebates to policyholders. Insurers would have to spend at least 80 percent of premium income on individual and small group policies, and 85 percent of large group funds.
No one could be denied coverage, or have their rates increased, because of pre-existing conditions, as of 2014, though the Saturday plan would bar insurers from denying coverage to children immediately.
Most consumers would be required to obtain coverage beginning in 2014 and would be able to shop for policies through health insurance exchanges, or marketplaces. Health insurers would not be allowed to participate if they dramatically increased premiums before exchanges were created.
Left intact were some key methods of paying for the plan, an excise tax on high-cost insurance policies and a projected $483 billion savings in Medicare and other government health programs.
But there was a change that's likely to be controversial. The original Senate bill included a 0.5 percentage point increase in the Medicare tax for individuals with wagers above $200,000 and families earning more than $250,000. The new plan would raise that percentage to 0.9 percent. The tax rate is now 1.45 percent.
A 5 percent tax on cosmetic surgery was dropped, but a 10 percent tax on tanning salon services was added, and a key small business tax credit would take effect next year, not in 2011 as originally proposed.
On abortion, the bill will ensure that no public funds will be used for abortion, except those now allowed, and require that every state provide an insurance plan option that does not cover abortion. The measure also provides each state the right to pass a law barring insurance coverage for abortion within state borders.
The House of Representatives health care bill puts strict limits on federal funding of abortion, allowing such funds to be used only in cases of rape, incest or where 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.
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