Senate health bill's cost at $849B

WASHINGTON - Setting up a historic year-end debate, Senate Democratic leader Harry Reid last night unveiled his long-awaited version of legislation to reshape the nation's health-care system.

The measure, estimated to cost $849 billion over 10 years, would extend coverage to 94 percent of those eligible and bar insurance firms from denying coverage because of preexisting medical conditions. Currently, 83 percent of Americans have health insurance.

At its core, it would set up insurance marketplaces - called exchanges - primarily for those who have a hard time getting or keeping coverage. To provide price competition to private insurers, consumers would have the choice of buying government-sold insurance - except in states that opt out.

Consumers also would have the choice of buying policies that cover abortion or policies that do not.

To cover costs, the measure relies mainly on cuts in future Medicare spending as well as on higher Medicare payroll taxes for the wealthy. According to an outline of the bill, the higher taxes are designed also to lengthen the life of the trust fund that finances Medicare.

Aides said the mammoth, 2,074-page bill would reduce deficits by $127 billion over a decade and by as much as $650 billion in the 10 years that follow, citing as-yet-unreleased estimates by the Congressional Budget Office.

"Tonight begins the last leg of this journey," the Nevada Democrat told reporters, less than two weeks after the House approved its version - and nearly 10 months after President Obama's Inauguration Day summons to action.

Obama hailed Reid's action and said, "I look forward to working with the Senate and House to get a finished bill to my desk as soon as possible." He did not mention his longtime goal of signing health legislation by year's end.

Reid's Senate measure would require most Americans to carry health insurance and would provide hundreds of billions of dollars in subsidies to help those at lower incomes afford it.

Initial maneuvering on the Senate floor was expected later in the week on the measure, bitterly opposed by Republicans.

"This bill has been behind closed doors for weeks," said Sen. Mitch McConnell of Kentucky, the Republican leader. "Now, it's America's turn, and this will not be a short debate. Higher premiums, tax increases, and Medicare cuts to pay for more government. The American people know that is not reform."

After weeks of drafting, Reid outlined the legislation to rank-and-file Democratic senators at a closed-door meeting.

"Everyone was positive," said Sen. Amy Klobuchar (D., Minn.).

That didn't mean there weren't problems - far from it. At his news conference, Reid pointedly refrained from saying he had the 60 votes necessary to propel the bill over its first hurdle.

As rank-and-file Democrats gathered to learn details of the measure, a senior Democratic leadership aide said the CBO had estimated it would spread coverage to 31 million Americans who currently lack it while still reducing federal deficits by $127 billion over 10 years.

Senators emerging from their closed-door meeting with Reid provided further details of the bill.

Sen. John Kerry (D., Mass.) said all consumers who purchase insurance from private companies in the exchange would have access to abortion coverage.

He said plans without abortion coverage also would have to be sold, giving consumers a choice. That is less restrictive than a provision in the House-passed bill that has angered liberals and abortion-rights supporters.

In a sign of the challenge confronting Reid, the Nevada Democrat met earlier in the day with Sens. Ben Nelson of Nebraska, Mary Landrieu of Louisiana, and Blanche Lincoln of Arkansas, moderates within his party who have expressed reservations about the bill.

"He is walking through the particulars with them," said Reid's spokesman, Jim Manley. "We need 60 votes to get this bill to the floor."

Nelson later issued a statement strongly suggesting he would vote with fellow Democrats on an initial showdown expected within days. Landrieu said, "I'm not going to be for anything that doesn't drive down costs over time."

Lincoln, the only one of the three who faces reelection next year, told reporters, "We'll wait and see."

With the support of two independents, Democrats have 60 seats, the precise number needed to choke off any Republican delaying tactics. None of the 40 Republicans is expected to defect on the first test vote, which may come as early as Saturday.

Ahead lie weeks - if not more - of unpredictable maneuvering on the Senate floor, where Reid and his allies will seek to incorporate changes sought by Democrats and repel attempts by Republicans to defeat the legislation and inflict a significant political defeat on the president.

Reid was releasing his legislation more than a week after the House approved its version of the health-care bill on a near party-line vote of 220-215.

According to estimates from the CBO, the House bill, with a price tag of $1.2 trillion, also would result in coverage for tens of millions of uninsured, and provide 96 percent of the eligible population with insurance.

Two Senate committees approved different versions of a health-care bill earlier in the year, and while Reid has said he would produce a blend of the two proposals, in fact he had a virtual free hand to come up with a plan that could command the 60 votes needed to pass.