Senators vote today on fate of health bill

They will decide whether to take up the debate. Democrats still must persuade two of their members to come aboard.

By David Lightman

McClatchy Newspapers

WASHINGTON - The Senate is poised to approve today the start of a historic debate over health-care legislation aimed at making coverage easier, less expensive to obtain, and harder to lose.

Democrats need 60 votes to cut off a Republican-led effort to block consideration of the bill. A vote is scheduled to begin at 8 p.m. Democrats control 60 seats, but two moderates are wavering.

One previously undecided Democratic centrist, Nebraska's Ben Nelson, said yesterday that he would vote to proceed but stressed that his vote "is not for or against the new Senate health-care bill. . . . It is only to begin debate and an opportunity to make improvements."

Still undecided were Mary Landrieu of Louisiana and Blanche Lincoln of Arkansas, who is viewed as the most reluctant holdout.

Lincoln had insisted that the health-care bill be posted publicly on the Internet for 72 hours before the vote, which it was. That time expires when the vote is scheduled to start. The second-term senator faces the thorniest political situation: She is up for reelection next year, and polls show her prospects uncertain.

On the other hand, because today's vote can be painted largely as a procedural test, it's not likely to have much effect on Lincoln's political status, said Janine Parry, an associate professor of political science at the University of Arkansas.

"It's too inside baseball," she said.

Landrieu has had reservations about the bill's impact on small business as well as its cost, but the measure contains at least $100 million in potential aid to her state's Medicaid program, which provides coverage for the poor. Landrieu aides said that she had been fighting for the money for a long time but that its inclusion had nothing to do with how she might vote today.

Should the Senate vote to proceed, a full floor debate on the 2,074-page bill is expected to begin the week of Nov. 30 and continue at least through late December. The measure would cost an estimated $848 billion over 10 years and would be paid for by cuts in spending on Medicare and Medicaid and by raising a variety of taxes and fees.

It would require most Americans to obtain health insurance and would bar insurers from denying coverage because of preexisting conditions. People could shop for coverage through insurance exchanges, or marketplaces, and one of their options would be a new government-run health-insurance plan, or public option. Individual states could opt out of the plan.

The government plan is supposed to help bring down costs by making insurance more competitive and universal. The nonpartisan Congressional Budget Office, however, estimates that only three million to four million people would buy insurance through the plan, and their premiums probably would be "somewhat higher than the average premiums" for private plans sold through the exchange.

The House passed its version of the health-care overhaul Nov. 7. If the Senate passes legislation, the bills will be reconciled through House-Senate negotiations. Each chamber would vote on the resulting compromise, probably early next year.

First, however, the Senate needs to approve the vote today to proceed.

The Senate's health-care debate effectively began yesterday. Democrats spoke in terms both lofty and local.

"In the 27 years I've been in the Senate, we have not gotten to this point," said Sen. Jeff Bingaman (D., N.M.), who then detailed the bill's effects on his state.

Republicans said the measure was too expensive and ultimately would lead to rationed medical care.

They cited this week's controversy over mammograms. Monday, a government task force said most women didn't need mammograms in their 40s but should get them every other year after turning 50.

The American Cancer Society has recommended for years that annual screening begin at age 40. On Wednesday, Health and Human Services Secretary Kathleen Sebelius agreed that screening should be done at 40, advising women to "keep doing what you have been doing for years."

The flap, Republicans said, is typical of what's to come as the government gets more control over health care.

"This is how rationing starts," said Sen. Jon Kyl (R., Ariz.).

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