WASHINGTON — Democrats are calling the Senate's health-care bill a first big step toward insuring more Americans and controlling costs, while Republicans counter that it's the first step toward bigger government and higher taxes.
The two parties are locked in a fierce battle to sway public opinion, and whoever wins it will win the health-care struggle, which now looks likely to stretch into 2010.
The next legislative step is expected at about 7 a.m. Tuesday, when the Senate plans to take a second vote on cutting off a Republican-led debate on the Democrats' $871 billion plan. The first effort passed early Monday, 60 to 40, on a straight party-line vote.
If the Senate passes the bill later this week, as expected, negotiators from both chambers of Congress will begin trying to reconcile the Senate measure and one the House of Representatives passed last month.
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One threat to eventual passage is the public's view of the legislation, said Paul Ginsburg, the president of the Center for Studying Health System Change, a nonpartisan Washington research group.
It could take several weeks for the conference to produce a bill, and "that's a long time for public opinion to shift," he said, and its success, particularly in an election year, will depend on "how this plays out with the public over the next few months."
Signs of what could happen next are mixed.
"There's pretty broad agreement on a lot," said Elizabeth Carpenter, a health policy analyst at the New America Foundation, a center-left Washington research group.
Under both bills, insurers would be barred from rejecting anyone because of pre-existing conditions. Gone, too, would be the practice in many states of charging women more than men, and insurers would be limited in how much they could increase rates on older people.
Consumers would be able to shop for coverage through exchanges, much as they now scan the Internet for the best airline fares. Most people would have to obtain a certain level of coverage, and pay penalties if they fail to do so.
Both houses agree on financial help for people having trouble affording coverage: They both would provide aid to families earning up to about $88,000 per year.
What could derail the entire effort are areas in which Democratic leaders have struggled for months to find common ground: abortion, taxes and the public option.
Ultimately, Democrats will write the final bill, because they control 60 Senate seats — enough to cut off extended debate — and 258 of the House's 435 seats. However, that means appealing to the approximately 52 moderate-to-conservative Blue Dogs in the House, as well as to the eight to 12 centrist Democrats in the Senate.
That's likely to mean important concessions on the three big sticking points.
Already, liberals' yen for a government-run insurance alternative and giving women more access to elective abortions faded when moderate senators balked.
Sen. Ben Nelson, D-Neb., who over the weekend provided the crucial 60th vote to cut off debate, explained a big reason he went along: "The Senate health-care bill is not perfect. Yet it doesn't include a public option or taxpayer funding of abortion I worked to exclude."
One of the public option's biggest boosters, Sen. Russell Feingold, D-Wis., realized that without the moderates, the entire health-care bill could be defeated.
"While the loss of the public option is bitter pill to swallow, on balance the bill still delivers meaningful reform, and the cost of inaction is simply too high," he said.
What all this means, said Barbara Kennelly, the president of the Committee to Preserve Social Security and Medicare, is that bill supporters need to be reminded, "This is truly an opportunity to begin health-care reform."
That desire to at least provide a foundation for future action is what worries skeptics.
Abortion rights supporters worry that the Senate bill doesn't go much further than the House version, which restricts federal funding to instances in which a woman's life is in danger or she's a victim of rape or incest. Abortion opponents think the Senate bill, which has somewhat less restrictive requirements, goes too far.
Taxpayer groups see too many taxes going up, since the House version imposes a 5.4 percent surcharge on individuals with adjusted gross incomes of more than $500,000 and couples making more than $1 million.
The Senate version includes a 40 percent excise tax on more expensive insurance policies and a 0.9 percentage point increase in the 1.45 percent Medicare tax for individuals with wages of more than $200,000 and couples earning more than $250,000.
"Democratic leaders put together a bill so heavy with tax hikes, Medicare cuts and government intrusion that in the end their biggest problem wasn't convincing Republicans to support it, it was convincing Democrats," scoffed Senate Republican leader Mitch McConnell, R-Ky.
However, Senate Majority Leader Harry Reid, D-Nev., was cheered Monday by a new CNN/Opinion Research Corp. poll, which found that support for the Democrats' health-care bill was up 6 percentage points over the last two weeks.
That poll, though, also showed Democrats have a long way to go, as 56 percent still oppose the bill, while 42 percent support it.
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