After Senate passage, compromise begins for a real health care law

WASHINGTON — The Senate began its final, frantic steps toward passage of historic health care legislation on Sunday, as lawmakers and interest groups began turning their attention to the difficult battles over abortion, taxes and the public option that lie ahead.

The Senate early Monday morning is expected to cut off a Republican-led debate on the Democratic-authored $871 billion health care overhaul, a crucial step that will move the package close to final approval in that chamber later this week.

Once that happens, probably Wednesday or Thursday, the bill will have to be reconciled with the version the House of Representatives passed last month.

That task will be up to a conference, or negotiating, committee, which is expected to be dominated by senior lawmakers from both Houses close to Senate Majority Leader Harry Reid, D-Nevada, and House Speaker Nancy Pelosi, D-Calif.

White House officials are expected to be close to the talks; Chief of Staff Rahm Emanuel, Health and Human Services Secretary Kathleen Sebelius, Budget Director Peter Orszag and top health care adviser Nancy-Ann DeParle have all been frequent visitors to the Capitol in recent weeks to discuss strategy.

Many major points in both bills are roughly the same. Insurers would be barred from denying coverage because of pre-existing conditions. Nearly everyone would have to obtain coverage in four or five years. New exchanges, or marketplaces, would be created to help consumers shop for policies.

But there are sharp divisions over abortion, taxes and the public option.

Abortion has already come closest to making the legislation implode in both Houses.

Last minute deals with anti-abortion Democrats were needed to keep the bills alive. Passage in the senate is virtually assured after a painstakingly negotiated weekend agreement with Nebraska Sen. Ben Nelson, the last Democratic holdout on the bill, giving his state substantial new Medicaid aid, and placing strict limits on abortion.

The House version bars federal funding of elective abortions except in cases of rape, incest or where the life of the woman is endangered.

The Senate bill also 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. Plans that offer abortion coverage would have to keep an account for private premium dollars and another for federal money, and consumers would have to pay separately for the coverage. The measure also provides each state the right to pass a law barring insurance coverage for abortion within state borders.

Neither side seemed satisfied. "I am disappointed that women's access to full reproductive health care is again paying the price," said Rep. Lois Capps, D-Calif., a leading House abortion rights supporter.

But anti-abortion lawmakers also were not pleased. Rep. Bart Stupak, D-Mich., who led the House fight to limit abortion funding, said the Senate bill was "a dramatic shift in federal policy that would allow the federal government to subsidize insurance policies with abortion coverage."

Taxes also loom as a vexing issue. The Senate bill raises money by increasing the Medicare tax, now 1.45 percent, by 0.9 percentage points on individuals with wages of more than $200,000 and couples earning over $250,000. It also would impose a 40 percent excise tax on most high-end expensive insurance policies.

Many House Democrats, as well as some labor union officials, see the excise tax as a burden on the middle class, and prefer a 5.4 percent income tax surcharge, starting in 2011, on individuals with adjusted gross incomes of more than $500,000 and joint filers making more than $1 million.

What once seemed to be the biggest fight, though, the public option, may be cooling.

The House version would create a government-run plan to compete with the private sector, an idea the White House, Democratic leaders and liberals have all sought. And while that idea has strong Senate Democratic support, it lacks the backing of a handful of party moderates — enough to deny Reid the 60 votes he would need to cut off extended debate.

As a result, the version now before the Senate would allow national, privately run plans, at least one of which must be nonprofit, to be supervised by the federal Office of Management and Budget.

Asked if she could "live without a public option" at a meeting with reporters last week, Pelosi said, "It depends on what else is in the bill." After the Senate Saturday announced its compromise, Pelosi and House Majority Leader Steny Hoyer, D-Md., issued a joint statement that stayed away from endorsing or opposing anything specific.

"The Democratic Caucus is committed to middle class affordability, security for our seniors, responsibility to our children, and accountability for the insurance industry," it said, adding, ""On that basis, we look forward to working with the Obama Administration, the Senate, and our Caucus to reconcile our bills and send final legislation to the President's desk as soon as possible."

Sympathetic senators also seemed ready to accept something less than the public option.

"I'm deeply disappointed the public option is not in the bill," said Sen. Al Franken, D-Minn. But there were other features he liked, and said, "There is a huge victory for those of us interested in keeping costs down."


Joint Committee on Taxation analysis of Senate legislation

Congressional Budget Office analysis of Reid health care amendment

Congressional Budget Office analysis of Senate Democrats' health care bill

Text of Senate Democratic health care bill

Congressional Budget Office analysis of House health bill


Goldman: Low Road to High Finance

Senate now poised to adopt historic health care bill

Health bills would raise taxes well before changes roll out

Senate health bill about to enter a political minefield

Senate votes to begin debate on health care overhaul

For more McClatchy politics coverage visit Planet Washington