WASHINGTON — If Washington state's two senators had their way, the massive health care reform bill they will vote for Thursday morning would have looked far different.
It would have included a clear-cut, government-run health care option. It would have included far less restrictive language on abortion and done more to rein in runaway health care costs.
But Democratic Sens. Patty Murray and Maria Cantwell say the bill does include "vitally important" measures, and with 60 votes needed to pass anything in the Senate it will still make significant changes in the health care system.
"With a major piece of legislation, there are always things you don't get," Murray said. "But when I step back and look at this bill, it is historic."
Cantwell said parts of the bill were "disappointing" and there was plenty of room for improvement.
"The bill is not perfect," Cantwell said. "But the conflict and compromise involved in getting to this point should not obscure the magnitude of this legislative achievement."
The $871 billion Senate bill would help provide coverage to 30 million people currently uninsured, reduce the deficit by $132 billion, impose tighter restrictions on insurance companies — including banning the use of pre-existing conditions to deny coverage — and provide tax breaks to small businesses providing coverage.
Murray said she has received 10,000 letters and e-mails from Washington residents sharing their health care stories. The senator said there has been "so much attention to a few big things that when this is implemented, people will be amazed."
For instance, Murray said the bill would allow children to stay on their parents' health insurance until they turn 26 and, beginning next year, insurance companies can't use pre-existing conditions to deny coverage to children. The bill also would help reduce prescription drug costs for seniors by starting to close the so-called "doughnut hole," she said.
Murray and Cantwell successfully lobbied to include a provision in the Senate bill that would change the formula used to determine Medicare reimbursement rates for doctors and hospitals.
Because Washington state has one of the most efficient health care delivery systems in the nation, its doctors and hospitals have been shortchanged when it came to Medicare reimbursements. A growing number of doctors are refusing to take Medicare patients, a situation increasingly worrisome in rural areas.
"Washington state will be rewarded for its efficiency," Cantwell said.
As a member of the Senate Finance Committee, which had jurisdiction over the bill, Cantwell inserted language that would allow other states to set up basic health programs like the one in Washington state. States with such plans would be able to negotiate coverage rates with insurance companies, and the federal government will provide much of the funding.
Cantwell said Washington state has been able to drive down insurance rates for its basic health care plan by 40 percent.
"It is a form of public option," Cantwell said. "It uses state governments to drive down the cost of insurance."
Because of a budget crisis, Washington state is considering eliminating its Basic Health Program, which provides coverage to 65,000 people, Cantwell said. States with plans like Washington could apply for federal funding as soon as the bill becomes law.
Murray, Cantwell and the Senate's 98 other members have been working on the health care bill almost non-stop since Thanksgiving, working weekends and voting at 1 a.m.
Democratic leaders have been able to put together the 60 votes needed for passage, in part, by putting provisions in the bill that benefit specific states.
Neither Murray nor Cantwell criticized the process.
"There are 100 people in this chamber, and everyone puts their stamp on it," Cantwell said.
Murray said different states have different needs, and without such compromises the Senate wouldn't pass anything.
With the Senate scheduled to vote today at 7 a.m. EST, both senators should make it home to spend Christmas Eve with their families.
"I have no idea whether my mother even put up the tree," Cantwell said.
As for staying until the day before Christmas, Murray said, "If we get this done it will be worth it."